Provider Demographics
NPI:1568006419
Name:JACK, SAVANNAH ANN (AUD)
Entity type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:ANN
Last Name:JACK
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:SAVANNAH
Other - Middle Name:ANN
Other - Last Name:COVERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5012 US-75 SUITE 230
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020
Mailing Address - Country:US
Mailing Address - Phone:469-252-3510
Mailing Address - Fax:
Practice Address - Street 1:5012 US-75 SUITE 230
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020
Practice Address - Country:US
Practice Address - Phone:469-252-3510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-04
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
231H00000X
TX231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist