Provider Demographics
NPI:1174531552
Name:SNYDER, KATHERINE M (RD,LDN)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:M
Last Name:SNYDER
Suffix:
Gender:F
Credentials:RD,LDN
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:M
Other - Last Name:SNYDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD,LDN
Mailing Address - Street 1:2357 SEQUOIA DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-6222
Mailing Address - Country:US
Mailing Address - Phone:630-859-6800
Mailing Address - Fax:
Practice Address - Street 1:2285 SEQUOIA DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-6209
Practice Address - Country:US
Practice Address - Phone:630-859-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164-001125133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0451514334OtherBCBS PROVIDER#
IL0727500001Medicare NSC
IL0451514334OtherBCBS PROVIDER#
ILK02485Medicare ID - Type Unspecified