Provider Demographics
NPI:1548863244
Name:WALDER, SAVANNAH ROSE (CDCA)
Entity type:Individual
Prefix:MRS
First Name:SAVANNAH
Middle Name:ROSE
Last Name:WALDER
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 S EAST ST
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-2102
Mailing Address - Country:US
Mailing Address - Phone:330-388-8238
Mailing Address - Fax:
Practice Address - Street 1:801 E WASHINGTON ST STE 150
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-3336
Practice Address - Country:US
Practice Address - Phone:330-722-1069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH174959OtherCDCA