Provider Demographics
NPI:1871106450
Name:SNYDER, LISA ELAINE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ELAINE
Last Name:SNYDER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ELAINE
Other - Last Name:DURRANT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CF-SLP
Mailing Address - Street 1:130 MINERVA ST
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-1560
Mailing Address - Country:US
Mailing Address - Phone:419-447-1566
Mailing Address - Fax:
Practice Address - Street 1:130 MINERVA ST
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-1560
Practice Address - Country:US
Practice Address - Phone:419-447-1566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.14080235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSP.14080Medicaid