Provider Demographics
NPI:1194510040
Name:SNOWDEN, KEITHRA LAUREESE
Entity type:Individual
Prefix:
First Name:KEITHRA
Middle Name:LAUREESE
Last Name:SNOWDEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4554 E AVENUE R6
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93552-3747
Mailing Address - Country:US
Mailing Address - Phone:323-402-6791
Mailing Address - Fax:
Practice Address - Street 1:41769 11TH ST W STE A
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-1418
Practice Address - Country:US
Practice Address - Phone:661-947-9554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician