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General NPI Number Information
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NPI Number | 1669281218
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Entity Type | Individual
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Provider Name | SAVANNAH L GRAY
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Gender | Female
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Dates
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Enumeration Date | 01/07/2025
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 207 W LINCOLN ST STE 1
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City | AUGUSTA
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State | WI
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Zip | 54722-9162
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Country | US
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Telephone | 715-286-6701
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Fax | 715-286-6018
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Provider Business Mailing Address
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Address Line | 15735 W US HIGHWAY 63
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City | HAYWARD
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State | WI
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Zip | 54843-6475
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Country | US
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Telephone | 715-934-0710
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Fax | 715-598-4881
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 8237
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License Number State | WI
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