Provider Demographics
NPI:1760817464
Name:SNYDER, CONSTANCE MARIE (BS, DT)
Entity Type:Individual
Prefix:MISS
First Name:CONSTANCE
Middle Name:MARIE
Last Name:SNYDER
Suffix:
Gender:F
Credentials:BS, DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 EDWARDS AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60164-2231
Mailing Address - Country:US
Mailing Address - Phone:708-606-7831
Mailing Address - Fax:708-409-0527
Practice Address - Street 1:118 EDWARDS AVE
Practice Address - Street 2:
Practice Address - City:NORTHLAKE
Practice Address - State:IL
Practice Address - Zip Code:60164-2231
Practice Address - Country:US
Practice Address - Phone:708-606-7831
Practice Address - Fax:708-409-0527
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist