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: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 W SERGEANT COURT DR STE 204
SARATOGA SPRINGS UT
84045-5809
US

IV. Provider business mailing address

2702 S SPRING MEADOW DR
SARATOGA SPRINGS UT
84045-6668
US

V. Phone/Fax

Practice location:
  • Phone: 801-987-6333
  • Fax:
Mailing address:
  • Phone: 801-259-8144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: