Provider Demographics
NPI:1255122370
Name:DAUGHERTY, SAVANNAH ELISE (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SAVANNAH
Middle Name:ELISE
Last Name:DAUGHERTY
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 1:1128 GREGORY LN
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40342-9484
Mailing Address - Country:US
Mailing Address - Phone:502-218-8183
Mailing Address - Fax:
Practice Address - Street 1:4603 TIMBERWALK CT # 575-8129
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-6746
Practice Address - Country:US
Practice Address - Phone:703-575-8129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY298017235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist