Provider Demographics
NPI:1467831438
Name:WETHERILL, SAVANAH (MS)
Entity Type:Individual
Prefix:
First Name:SAVANAH
Middle Name:
Last Name:WETHERILL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 NE MINNEHAHA ST APT 68
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-1303
Mailing Address - Country:US
Mailing Address - Phone:702-370-6406
Mailing Address - Fax:
Practice Address - Street 1:611 GRAND BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-4918
Practice Address - Country:US
Practice Address - Phone:360-696-6525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-23
Last Update Date:2016-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15628235Z00000X
WALL60681911235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist