Provider Demographics
NPI:1568756906
Name:SNYDER, CARRIE TILLEY (AUD)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:TILLEY
Last Name:SNYDER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 PATTON AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-3233
Mailing Address - Country:US
Mailing Address - Phone:601-508-3094
Mailing Address - Fax:
Practice Address - Street 1:204 KEY DR STE A
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-5010
Practice Address - Country:US
Practice Address - Phone:601-351-5433
Practice Address - Fax:601-779-9155
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-02
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSA3567231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist