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1891479804 NPI number — SAVANNAH MARIE STIDHAMS MA

NPI Number: 1891479804
Health Care Provider/Practitioner: SAVANNAH MARIE STIDHAMS MA

Information about “1891479804” NPI (SAVANNAH MARIE STIDHAMS MA) exists in 1891479804 in HTML format HTML  |  1891479804 in plain Text format TXT  |  1891479804 in PDF (Portable Document Format) PDF  |  1891479804 in an XML format XML  formats.

NPI Number : 1891479804 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1891479804",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "STIDHAMS",
    "FirstName": "SAVANNAH",
    "MiddleName": "MARIE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "19725 76TH AVE W APT 6B",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LYNNWOOD",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98036-5826",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "425-327-6235",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4030 LAKE WASHINGTON BLVD NE STE 201",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "KIRKLAND",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98033-7870",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "206-414-8918",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/12/2023",
    "LastUpdateDate": "06/12/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "101YM0800X",
        "TaxonomyName": "Mental Health Counselor",
        "LicenseNumber": null,
        "LicenseNumberStateCode": "WA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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