=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033082094
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAVANNA JEANINE BLAKE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2025
-----------------------------------------------------
Last Update Date | 09/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13944 S ACADEMY AVE
-----------------------------------------------------
City | KINGSBURG
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93631-9207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-868-5250
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1125 LAUREL LN
-----------------------------------------------------
City | LEMOORE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93245-2556
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------