Provider Demographics
NPI:1740916592
Name:MOCK, SAVANNAH ANNE (MS, SLP)
Entity type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:ANNE
Last Name:MOCK
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:
Other - First Name:SAVANNAH
Other - Middle Name:ANNE
Other - Last Name:BUSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6245 STATE ROAD 54
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-6006
Mailing Address - Country:US
Mailing Address - Phone:727-376-1111
Mailing Address - Fax:727-376-1113
Practice Address - Street 1:5741 GALL BLVD
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-3453
Practice Address - Country:US
Practice Address - Phone:727-376-1111
Practice Address - Fax:727-376-1113
Is Sole Proprietor?:No
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist