Provider Demographics
NPI:1447326301
Name:SNYDER, GARY RUSSELL (PHD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:RUSSELL
Last Name:SNYDER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15446 BEL RED ROAD NE
Mailing Address - Street 2:SUITE 430
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-5507
Mailing Address - Country:US
Mailing Address - Phone:425-885-3535
Mailing Address - Fax:
Practice Address - Street 1:15446 BEL RED ROAD NE
Practice Address - Street 2:SUITE 430
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-5507
Practice Address - Country:US
Practice Address - Phone:425-885-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1110103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WASN5020OtherREGANCE RIDER #