Basic Information
| Provider Information | |||||||||
| NPI: | 1356459655 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SNELL | ||||||||
| FirstName: | KRISTINE | ||||||||
| MiddleName: | WILL | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSW LISW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15507 MOSELEY ROAD | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402981645 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4255 NORTHFIELD RD | ||||||||
| Address2: | |||||||||
| City: | HIGHLAND HILLS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2162929700 | ||||||||
| FaxNumber: | 2162929721 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 19266 | OH | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.