Provider Demographics
NPI:1124883129
Name:GAZDECKI, SAVANAH HOPE (MA CCC SLP)
Entity type:Individual
Prefix:
First Name:SAVANAH
Middle Name:HOPE
Last Name:GAZDECKI
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 N IMBODEN ST APT 301
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-5485
Mailing Address - Country:US
Mailing Address - Phone:810-588-0936
Mailing Address - Fax:
Practice Address - Street 1:201 MASSACHUSETTS AVE NE STE C9
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-4988
Practice Address - Country:US
Practice Address - Phone:202-544-5469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCSLP200001580235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist