Healthcare Provider Details

I. General information

NPI: 1659020196
Provider Name (Legal Business Name): SAVANNAH RRAINE WASHBURN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6232 S 900 E
MURRAY UT
84121-2471
US

IV. Provider business mailing address

3737 W 4100 S STE 201
WEST VALLEY CITY UT
84120-5439
US

V. Phone/Fax

Practice location:
  • Phone: 888-949-4864
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-81676
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: