Provider Demographics
NPI:1609229590
Name:SNEDIGAR, KIERNAN DAVIS (QMHA, BA)
Entity Type:Individual
Prefix:
First Name:KIERNAN
Middle Name:DAVIS
Last Name:SNEDIGAR
Suffix:
Gender:F
Credentials:QMHA, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 W B ST STE J
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-4594
Mailing Address - Country:US
Mailing Address - Phone:417-621-9715
Mailing Address - Fax:541-727-5367
Practice Address - Street 1:175 W B ST STE J
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477
Practice Address - Country:US
Practice Address - Phone:541-762-1971
Practice Address - Fax:541-727-5367
Is Sole Proprietor?:No
Enumeration Date:2016-07-15
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500711355Medicaid