Provider Demographics
NPI:1770477424
Name:SNYDER, MADISON O (LADC)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:O
Last Name:SNYDER
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4232 DAHLBERG DR # A
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4805
Mailing Address - Country:US
Mailing Address - Phone:612-874-9811
Mailing Address - Fax:612-874-9820
Practice Address - Street 1:7308 112TH AVE N
Practice Address - Street 2:
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-3312
Practice Address - Country:US
Practice Address - Phone:763-843-8896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-06
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN307164101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)