Provider Demographics
NPI:1386851343
Name:SNEDDEN, MARY KAY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KAY
Last Name:SNEDDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2402 NORTHWEST 195TH PLACE
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-2932
Mailing Address - Country:US
Mailing Address - Phone:206-364-3777
Mailing Address - Fax:206-364-3999
Practice Address - Street 1:2402 NORTHWEST 195TH PLACE
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98177-2932
Practice Address - Country:US
Practice Address - Phone:206-364-3777
Practice Address - Fax:206-364-3999
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00003297235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7300965Medicaid