Provider Demographics
NPI:1902873367
Name:SNELL, MARILYN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:
Last Name:SNELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8033 ROYAL LN
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093-6429
Mailing Address - Country:US
Mailing Address - Phone:801-733-4855
Mailing Address - Fax:
Practice Address - Street 1:11075 S STATE ST
Practice Address - Street 2:SUITE 28
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-5164
Practice Address - Country:US
Practice Address - Phone:801-501-8444
Practice Address - Fax:801-501-7317
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4768986-2501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist