Provider Demographics
NPI:1134675846
Name:MOTZKO, SAVANNAH ROSE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:SAVANNAH
Middle Name:ROSE
Last Name:MOTZKO
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 VICKIE CIR
Mailing Address - Street 2:
Mailing Address - City:BERRYVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72616-5202
Mailing Address - Country:US
Mailing Address - Phone:870-480-6959
Mailing Address - Fax:870-533-5533
Practice Address - Street 1:1919 NORTHEASTERN AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-2934
Practice Address - Country:US
Practice Address - Phone:501-982-7571
Practice Address - Fax:501-241-2054
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR220010721Medicaid