Individual
DAYNA VIVACQUA REVETTI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA CCC-SLP
Contact information
Practice address
135 HERON BAY DR, POLAND, OH 44514-3200
(330) 720-0915
Mailing address
135 HERON BAY DR, POLAND, OH 44514-3200
(330) 720-0915
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP10018
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2095254
—
OH
Enumeration date
11/23/2011
Last updated
05/23/2023
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