Healthcare Provider Details

I. General information

NPI: 1407304553
Provider Name (Legal Business Name): SAVANNAH JOY GESKE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2016
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 S DON ROSER DR
LAS CRUCES NM
88011-4550
US

IV. Provider business mailing address

1635 S DON ROSER DR
LAS CRUCES NM
88011-4550
US

V. Phone/Fax

Practice location:
  • Phone: 575-636-2506
  • Fax:
Mailing address:
  • Phone: 816-932-4576
  • Fax: 816-932-5793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2016034032
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberPSY-2024-0093
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: