Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 6801015739 | MI |
N | 1041C0700X | Clinical Social Worker | 6801015739 | MI |
NPI | 1003042755 |
---|---|
Provider Name | Ms. Melanie Barbara Snyder-Lindblom |
First Address | Birmingham, MI 48009-1519 |
Second Address | Pontiac, MI 48341-1420 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2009 |
Last Update Date | 09/06/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0892585 | BC/BS (01) | MI |