Provider Demographics
NPI:1710548516
Name:SNYDER, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:SNYDER
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 1:9822 NY - 16
Mailing Address - Street 2:
Mailing Address - City:MACHIAS
Mailing Address - State:NY
Mailing Address - Zip Code:14101
Mailing Address - Country:US
Mailing Address - Phone:716-353-8516
Mailing Address - Fax:
Practice Address - Street 1:9822 NY-16
Practice Address - Street 2:
Practice Address - City:MACHIAS
Practice Address - State:NY
Practice Address - Zip Code:14101
Practice Address - Country:US
Practice Address - Phone:716-353-8516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028798-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist