Healthcare Provider Details

I. General information

NPI: 1215849666
Provider Name (Legal Business Name): SAVANNAH WOLFE RBT
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 INDEPENDENCE PKWY # 200
PLANO TX
75075-8016
US

IV. Provider business mailing address

2400 DALLAS PKWY STE 400
PLANO TX
75093-4381
US

V. Phone/Fax

Practice location:
  • Phone: 469-573-2469
  • Fax:
Mailing address:
  • Phone: 469-573-2469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number26-547695
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: