Provider Demographics
NPI:1174714851
Name:LEWIS-SNYDER, GRETCHEN RANEE (LP)
Entity type:Individual
Prefix:DR
First Name:GRETCHEN
Middle Name:RANEE
Last Name:LEWIS-SNYDER
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11900 WAYZATA BLVD
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-2031
Mailing Address - Country:US
Mailing Address - Phone:612-719-5422
Mailing Address - Fax:
Practice Address - Street 1:11900 WAYZATA BLVD
Practice Address - Street 2:SUITE 216E
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-2031
Practice Address - Country:US
Practice Address - Phone:612-719-5422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4976103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist