Healthcare Provider Details

I. General information

NPI: 1124613773
Provider Name (Legal Business Name): SAVANNAH NIESHE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2021
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E CLAY AVE # 201
CHEWELAH WA
99109-8936
US

IV. Provider business mailing address

165 E HAWTHORNE AVE
COLVILLE WA
99114-2629
US

V. Phone/Fax

Practice location:
  • Phone: 509-935-4808
  • Fax:
Mailing address:
  • Phone: 509-684-4597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: