Provider Demographics
NPI:1295524700
Name:BROCK, SAVANNAH HOPE
Entity type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:HOPE
Last Name:BROCK
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:SAVANNAH
Other - Middle Name:HOPE
Other - Last Name:BECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21033 LARSON RD
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65583-3541
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21033 LARSON RD
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:MO
Practice Address - Zip Code:65583-3541
Practice Address - Country:US
Practice Address - Phone:573-433-1955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program