Provider Demographics
NPI:1114275765
Name:SNYDER, JULIE
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:SNYDER
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 1:3009 N CLIFTON AVE
Mailing Address - Street 2:#103
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-4333
Mailing Address - Country:US
Mailing Address - Phone:773-633-3772
Mailing Address - Fax:
Practice Address - Street 1:3009 N CLIFTON AVE
Practice Address - Street 2:#103
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-4333
Practice Address - Country:US
Practice Address - Phone:773-633-3772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146011258235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist