Provider Demographics
NPI:1215652573
Name:EMMONS, SAVANNAH BAILEY
Entity type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:BAILEY
Last Name:EMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8702 FOUNDERS RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-1337
Mailing Address - Country:US
Mailing Address - Phone:317-900-1030
Mailing Address - Fax:
Practice Address - Street 1:8702 FOUNDERS RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-1337
Practice Address - Country:US
Practice Address - Phone:317-900-1030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-21-185747106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician