Provider Demographics
NPI:1609004522
Name:SNOGREN, FERN L (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:FERN
Middle Name:L
Last Name:SNOGREN
Suffix:
Gender:F
Credentials:LCSW
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 1426
Mailing Address - Street 2:
Mailing Address - City:TALENT
Mailing Address - State:OR
Mailing Address - Zip Code:97540-8519
Mailing Address - Country:US
Mailing Address - Phone:541-631-5044
Mailing Address - Fax:541-631-2638
Practice Address - Street 1:629 ALTAMONT ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-0157
Practice Address - Country:US
Practice Address - Phone:541-482-3328
Practice Address - Fax:541-982-2265
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL51911041C0700X
UNLICENSED101Y00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR45-4333362OtherTAX IDENTIFICATION NUMBER