Provider Demographics
NPI:1306217088
Name:SNELLGROVE, MORGAN RENEE (LSW)
Entity Type:Individual
Prefix:MISS
First Name:MORGAN
Middle Name:RENEE
Last Name:SNELLGROVE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 94
Mailing Address - Street 2:239A OLD NATIONAL ROAD
Mailing Address - City:OLD WASHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43768-0094
Mailing Address - Country:US
Mailing Address - Phone:740-489-5571
Mailing Address - Fax:740-489-5004
Practice Address - Street 1:239A OLD NATIONAL ROAD
Practice Address - Street 2:
Practice Address - City:OLD WASHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43768-0094
Practice Address - Country:US
Practice Address - Phone:740-489-5571
Practice Address - Fax:740-489-5004
Is Sole Proprietor?:No
Enumeration Date:2015-10-07
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.15006571041S0200X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool