Provider Demographics
NPI:1285111997
Name:SIERRA NEVADA NEUROPSYCHOLOGY
Entity type:Organization
Organization Name:SIERRA NEVADA NEUROPSYCHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:D
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:530-446-6164
Mailing Address - Street 1:177 BOVET RD FL 6
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-3122
Mailing Address - Country:US
Mailing Address - Phone:888-570-1020
Mailing Address - Fax:888-384-0984
Practice Address - Street 1:900 E MAIN ST STE 106
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5853
Practice Address - Country:US
Practice Address - Phone:530-446-6164
Practice Address - Fax:530-446-6377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-25
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty