Healthcare Provider Details

I. General information

NPI: 1922672203
Provider Name (Legal Business Name): SAVANNAH RIO HOLLAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 TACOMA AVE S
TACOMA WA
98402-1910
US

IV. Provider business mailing address

5015 FAIRWOOD BLVD NE APT 45
TACOMA WA
98422-2110
US

V. Phone/Fax

Practice location:
  • Phone: 253-396-5800
  • Fax:
Mailing address:
  • Phone: 206-475-7769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: