Provider Demographics
NPI:1457771354
Name:SNEGIREFF, ANA
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:
Last Name:SNEGIREFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 DEER RUN LN
Mailing Address - Street 2:
Mailing Address - City:WOODBURN
Mailing Address - State:OR
Mailing Address - Zip Code:97071-5875
Mailing Address - Country:US
Mailing Address - Phone:503-949-3180
Mailing Address - Fax:503-385-8692
Practice Address - Street 1:4722 OAK PARK DR NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-2928
Practice Address - Country:US
Practice Address - Phone:503-584-1631
Practice Address - Fax:503-385-8692
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-18
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR523759103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral