Provider Demographics
NPI:1972173607
Name:SNYDER, MADISON NICOLE (CFY-SLP)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:NICOLE
Last Name:SNYDER
Suffix:
Gender:F
Credentials:CFY-SLP
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:NICOLE
Other - Last Name:WIESEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CFY-SLP
Mailing Address - Street 1:239 BENTLEY OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33823-2053
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1755 N FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-3109
Practice Address - Country:US
Practice Address - Phone:863-680-7000
Practice Address - Fax:866-264-8519
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-25
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA20179235Z00000X
FLSZ100082235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist