Provider Demographics
NPI:1881433134
Name:MOYNIHAN, SAVANNAH LYNNE-MARIE
Entity type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:LYNNE-MARIE
Last Name:MOYNIHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SAVANNAH
Other - Middle Name:
Other - Last Name:MOYNIHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:204 E RIVER ST
Mailing Address - Street 2:
Mailing Address - City:ILION
Mailing Address - State:NY
Mailing Address - Zip Code:13357-1310
Mailing Address - Country:US
Mailing Address - Phone:315-219-7063
Mailing Address - Fax:
Practice Address - Street 1:1085 EGGERT RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-4148
Practice Address - Country:US
Practice Address - Phone:716-831-8422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist