Provider Demographics
NPI:1629142369
Name:SNOW-GRIFFIN, LINDA J (PHD)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:J
Last Name:SNOW-GRIFFIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:J
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:7770 WEST CHESTER RD
Mailing Address - Street 2:# 250
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069
Mailing Address - Country:US
Mailing Address - Phone:513-779-6018
Mailing Address - Fax:513-779-6762
Practice Address - Street 1:7770 WEST CHESTER RD
Practice Address - Street 2:# 250
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069
Practice Address - Country:US
Practice Address - Phone:513-779-6018
Practice Address - Fax:513-779-6762
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3404103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0883852Medicaid
OHCP07521Medicare PIN
OH0883852Medicaid