Healthcare Provider Details

I. General information

NPI: 1891479804
Provider Name (Legal Business Name): SAVANNAH MARIE STIDHAMS MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 06/12/2023
Certification Date: 06/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4030 LAKE WASHINGTON BLVD NE STE 201
KIRKLAND WA
98033-7870
US

IV. Provider business mailing address

19725 76TH AVE W APT 6B
LYNNWOOD WA
98036-5826
US

V. Phone/Fax

Practice location:
  • Phone: 206-414-8918
  • Fax:
Mailing address:
  • Phone: 425-327-6235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: