Provider Demographics
NPI:1134834781
Name:LIDEL, SAVANNAH RHEA (MS CF-SLP)
Entity type:Individual
Prefix:MRS
First Name:SAVANNAH
Middle Name:RHEA
Last Name:LIDEL
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:SAVANNAH
Other - Middle Name:RHEA
Other - Last Name:MCCORMACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 S RITCHIE AVE
Mailing Address - Street 2:
Mailing Address - City:RAVENSWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:26164-1721
Mailing Address - Country:US
Mailing Address - Phone:304-273-9385
Mailing Address - Fax:
Practice Address - Street 1:200 S RITCHIE AVE
Practice Address - Street 2:
Practice Address - City:RAVENSWOOD
Practice Address - State:WV
Practice Address - Zip Code:26164-1721
Practice Address - Country:US
Practice Address - Phone:304-273-9385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV0982235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist