Provider Demographics
NPI:1699234682
Name:SNOWDON, JACK
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:
Last Name:SNOWDON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3513 PENN AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15201-1373
Mailing Address - Country:US
Mailing Address - Phone:412-335-7413
Mailing Address - Fax:
Practice Address - Street 1:5035 CLAIRTON BLVD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15236-2103
Practice Address - Country:US
Practice Address - Phone:412-440-0142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist