Provider Demographics
NPI:1912419193
Name:CARDONA, SAVANNA KAY (LLMSW)
Entity type:Individual
Prefix:
First Name:SAVANNA
Middle Name:KAY
Last Name:CARDONA
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:SAVANNA
Other - Middle Name:
Other - Last Name:MOWL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 MAPLE ST STE 215
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-5966
Mailing Address - Country:US
Mailing Address - Phone:734-361-1416
Mailing Address - Fax:
Practice Address - Street 1:100 MAPLE ST STE 215
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-5966
Practice Address - Country:US
Practice Address - Phone:734-361-1416
Practice Address - Fax:734-245-8462
Is Sole Proprietor?:No
Enumeration Date:2017-10-28
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511189221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1043554348OtherGENESEE HEALTH SYSTEM