Healthcare Provider Details

I. General information

NPI: 1699418152
Provider Name (Legal Business Name): SAVANNAH N OMOTTO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SAVANNAH N OMOTTO-MARTIN

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 MARTIN LUTHER KING JR WAY S
SEATTLE WA
98144-4801
US

IV. Provider business mailing address

1901 MARTIN LUTHER KING JR WAY S
SEATTLE WA
98144-4801
US

V. Phone/Fax

Practice location:
  • Phone: 980-298-1460
  • Fax: 206-726-7585
Mailing address:
  • Phone: 206-322-7676
  • Fax: 206-726-7585

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: