Healthcare Provider Details

I. General information

NPI: 1649544818
Provider Name (Legal Business Name): SAVANNAH HARDIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2012
Last Update Date: 03/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 HOUSTON OAKS DR
PARIS KY
40361-2704
US

IV. Provider business mailing address

320 DUNBAR LN
RICHMOND KY
40475-9285
US

V. Phone/Fax

Practice location:
  • Phone: 606-584-1169
  • Fax: 800-584-1465
Mailing address:
  • Phone: 606-584-1169
  • Fax: 800-584-1465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number10-004A
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: