Healthcare Provider Details

I. General information

NPI: 1306700133
Provider Name (Legal Business Name): SAVANNAH DERBY
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6781 N THORNYDALE RD STE 203
TUCSON AZ
85741-2772
US

IV. Provider business mailing address

6781 N THORNYDALE RD STE 203
TUCSON AZ
85741-2772
US

V. Phone/Fax

Practice location:
  • Phone: 520-982-3484
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA16366
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: