Provider Demographics
NPI:1396583829
Name:SNODGRASS, CANDACE (PHD)
Entity type:Individual
Prefix:DR
First Name:CANDACE
Middle Name:
Last Name:SNODGRASS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 4TH ST NW STE 115
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-3155
Mailing Address - Country:US
Mailing Address - Phone:218-556-5416
Mailing Address - Fax:
Practice Address - Street 1:403 4TH ST NW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-3142
Practice Address - Country:US
Practice Address - Phone:218-214-9389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist