Provider Demographics
NPI:1437822467
Name:SERGENT, SAVANNAH GRACE (MS SLP-CFY)
Entity Type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:GRACE
Last Name:SERGENT
Suffix:
Gender:F
Credentials:MS SLP-CFY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 445
Mailing Address - Street 2:
Mailing Address - City:BENHAM
Mailing Address - State:KY
Mailing Address - Zip Code:40807-0445
Mailing Address - Country:US
Mailing Address - Phone:606-273-7777
Mailing Address - Fax:
Practice Address - Street 1:130 KATE IRELAND DR
Practice Address - Street 2:
Practice Address - City:HYDEN
Practice Address - State:KY
Practice Address - Zip Code:41749-9071
Practice Address - Country:US
Practice Address - Phone:606-672-1127
Practice Address - Fax:606-672-1966
Is Sole Proprietor?:No
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY271085235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist