Provider Demographics
NPI:1619029279
Name:SNYDER, LENN MARC (LCSW)
Entity type:Individual
Prefix:MR
First Name:LENN
Middle Name:MARC
Last Name:SNYDER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 HILLCREST ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-2816
Mailing Address - Country:US
Mailing Address - Phone:541-488-8195
Mailing Address - Fax:
Practice Address - Street 1:208 OAK ST
Practice Address - Street 2:SUITE 201
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1871
Practice Address - Country:US
Practice Address - Phone:541-488-8195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL003171101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
131904Medicare ID - Type Unspecified