Provider Demographics
NPI:1982734984
Name:SNIDER, MELODY L (PHD)
Entity type:Individual
Prefix:DR
First Name:MELODY
Middle Name:L
Last Name:SNIDER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MELODY
Other - Middle Name:
Other - Last Name:HUSKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:2498 N STOKESBERRY PL
Mailing Address - Street 2:SUITE 150
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-5150
Mailing Address - Country:US
Mailing Address - Phone:208-957-5450
Mailing Address - Fax:208-957-5292
Practice Address - Street 1:2498 N STOKESBERRY PL
Practice Address - Street 2:SUITE 150
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-5150
Practice Address - Country:US
Practice Address - Phone:208-957-5450
Practice Address - Fax:208-957-5292
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY-202392103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID16200124OtherMEDICARE GROUP PIN
IDN6316OtherBLUE CROSS
ID16200124OtherMEDICARE GROUP PIN
ID16200124OtherMEDICARE GROUP PIN