=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346653961
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAVANNAH MILLER LICSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2014
-----------------------------------------------------
Last Update Date | 02/19/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 GLOVER STREET
-----------------------------------------------------
City | TWISP
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98856
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-630-5678
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 314
-----------------------------------------------------
City | TWISP
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98856-0314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-630-5678
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | CG60479430
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LW60780445
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------