Provider Demographics
NPI:1427013259
Name:SNYDER, JODI D (PSYD)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:D
Last Name:SNYDER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 E MAIN ST
Mailing Address - Street 2:STE 106
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5853
Mailing Address - Country:US
Mailing Address - Phone:844-660-0355
Mailing Address - Fax:530-446-6377
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17470103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL174700Medicare ID - Type Unspecified