Healthcare Provider Details

I. General information

NPI: 1083546378
Provider Name (Legal Business Name): SAVANNAH MOSELEY
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1404 RACE ST STE 302
CINCINNATI OH
45202-7366
US

IV. Provider business mailing address

1404 RACE ST STE 302
CINCINNATI OH
45202-7366
US

V. Phone/Fax

Practice location:
  • Phone: 865-385-2639
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number000758223
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: