Provider Demographics
NPI:1629612908
Name:SNODGRASS, MARISA R
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:R
Last Name:SNODGRASS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARISA
Other - Middle Name:
Other - Last Name:BOYD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:115 PRIVATE ROAD 977
Mailing Address - Street 2:
Mailing Address - City:PEDRO
Mailing Address - State:OH
Mailing Address - Zip Code:45659-8608
Mailing Address - Country:US
Mailing Address - Phone:740-534-1386
Mailing Address - Fax:740-534-1497
Practice Address - Street 1:115 PRIVATE ROAD 977
Practice Address - Street 2:
Practice Address - City:PEDRO
Practice Address - State:OH
Practice Address - Zip Code:45659-8608
Practice Address - Country:US
Practice Address - Phone:740-534-1386
Practice Address - Fax:740-534-1497
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-30
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional