Provider Demographics
NPI:1528762721
Name:SNIDER, GRACE EMILY YAJUN
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:EMILY YAJUN
Last Name:SNIDER
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 1:1151 E US HIGHWAY 36
Mailing Address - Street 2:
Mailing Address - City:TUSCOLA
Mailing Address - State:IL
Mailing Address - Zip Code:61953-8043
Mailing Address - Country:US
Mailing Address - Phone:217-991-0289
Mailing Address - Fax:
Practice Address - Street 1:101 W WINDSOR RD
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61802-6663
Practice Address - Country:US
Practice Address - Phone:217-991-0289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist