Provider Demographics
NPI:1982899209
Name:SNODGRASS, CAROL ANN (RN - CBT)
Entity Type:Individual
Prefix:MRS
First Name:CAROL ANN
Middle Name:
Last Name:SNODGRASS
Suffix:
Gender:F
Credentials:RN - CBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 SW 152ND ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-1700
Mailing Address - Country:US
Mailing Address - Phone:253-686-0677
Mailing Address - Fax:
Practice Address - Street 1:1800 SW 152ND ST
Practice Address - Street 2:SUITE A
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-1700
Practice Address - Country:US
Practice Address - Phone:253-686-0677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00135967247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other