Provider Demographics
NPI:1013731686
Name:MURDOCK, SAVANNAH (CCC-SLP)
Entity type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:
Last Name:MURDOCK
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2151 ANDERSON GIBSON RD APT 2407
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-2235
Mailing Address - Country:US
Mailing Address - Phone:815-641-6078
Mailing Address - Fax:
Practice Address - Street 1:2151 ANDERSON GIBSON RD APT 2407
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-2235
Practice Address - Country:US
Practice Address - Phone:815-641-6078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122490235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist