Provider Demographics
NPI:1942473137
Name:SNYDER, MICHELLE R (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:R
Last Name:SNYDER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 THOMPSON RD
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-2150
Mailing Address - Country:US
Mailing Address - Phone:541-269-2986
Mailing Address - Fax:541-269-7987
Practice Address - Street 1:1610 THOMPSON RD
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2150
Practice Address - Country:US
Practice Address - Phone:541-269-2986
Practice Address - Fax:541-269-7987
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL41591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical