Healthcare Provider Details

I. General information

NPI: 1265113013
Provider Name (Legal Business Name): SAVANNAH BLOW LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2023
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 N WASHINGTON AVE STE L1
LANSING MI
48906-5137
US

IV. Provider business mailing address

1720 NEMOKE TRL APT 3
HASLETT MI
48840-8616
US

V. Phone/Fax

Practice location:
  • Phone: 517-301-5011
  • Fax:
Mailing address:
  • Phone: 517-862-0948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: