Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1013273465 |
---|---|
Provider Name | Alicia Marie Snyder |
First Address | Centralia, IL 62801-4331 |
Second Address | Centralia, IL 62801-4331 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2012 |
Last Update Date | 10/04/2012 |