Provider Demographics
NPI:1194354605
Name:SNODDY, TYNESSIA NICOLE CHEROKEE
Entity type:Individual
Prefix:MS
First Name:TYNESSIA
Middle Name:NICOLE CHEROKEE
Last Name:SNODDY
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:PO BOX 252
Mailing Address - Street 2:
Mailing Address - City:OSSEO
Mailing Address - State:MN
Mailing Address - Zip Code:55369-0252
Mailing Address - Country:US
Mailing Address - Phone:612-226-3758
Mailing Address - Fax:
Practice Address - Street 1:1000 UNIVERSITY AVE W STE 20
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-4747
Practice Address - Country:US
Practice Address - Phone:612-373-2469
Practice Address - Fax:612-373-2470
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-06
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty