Healthcare Provider Details

I. General information

NPI: 1558080150
Provider Name (Legal Business Name): SAVANNAH TRAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2022
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5706 17TH AVE NW # 70432
SEATTLE WA
98107-5240
US

IV. Provider business mailing address

5706 17TH AVE NW # 70432
SEATTLE WA
98107-5240
US

V. Phone/Fax

Practice location:
  • Phone: 206-618-0882
  • Fax:
Mailing address:
  • Phone: 425-371-4173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMG70079421
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: