Provider Demographics
NPI:1962450817
Name:SNIDER KENT, JAN (PHD)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:
Last Name:SNIDER KENT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JAN
Other - Middle Name:
Other - Last Name:SNIDER KENT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:2650 E 32ND ST STE 221
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-4300
Mailing Address - Country:US
Mailing Address - Phone:417-623-1381
Mailing Address - Fax:417-623-0457
Practice Address - Street 1:2650 E 32ND ST STE 221
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-4300
Practice Address - Country:US
Practice Address - Phone:417-623-1381
Practice Address - Fax:417-623-0457
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01592103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000071304Medicare PIN