Provider Demographics
NPI:1023110061
Name:SNIDERWIN, MARY BETH (LSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:BETH
Last Name:SNIDERWIN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959
Mailing Address - Country:US
Mailing Address - Phone:618-997-5311
Mailing Address - Fax:618-993-4194
Practice Address - Street 1:2401 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959
Practice Address - Country:US
Practice Address - Phone:618-997-5311
Practice Address - Fax:618-993-4194
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.010670104100000X
IL14901364104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker