Provider Demographics
NPI:1811731995
Name:SNYDER, VIVIAN RIDDELL (BCBA)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:RIDDELL
Last Name:SNYDER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2286 JONES CREEK RD
Mailing Address - Street 2:
Mailing Address - City:WHITE BLUFF
Mailing Address - State:TN
Mailing Address - Zip Code:37187-4213
Mailing Address - Country:US
Mailing Address - Phone:615-422-7233
Mailing Address - Fax:209-265-1059
Practice Address - Street 1:2286 JONES CREEK RD
Practice Address - Street 2:
Practice Address - City:WHITE BLUFF
Practice Address - State:TN
Practice Address - Zip Code:37187-4213
Practice Address - Country:US
Practice Address - Phone:615-422-7233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12473688103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst