Provider Demographics
NPI:1679023725
Name:SNOW, KELLY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:SNOW
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 1:3809 MOUNTCLIFFE CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95136-1429
Mailing Address - Country:US
Mailing Address - Phone:408-628-9446
Mailing Address - Fax:
Practice Address - Street 1:3809 MOUNTCLIFFE CT
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95136-1429
Practice Address - Country:US
Practice Address - Phone:408-628-9446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator