Provider Demographics
NPI:1093416562
Name:WOLFGRAM, SAVANNAH JANE
Entity Type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:JANE
Last Name:WOLFGRAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 PROSPERITY DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4718
Mailing Address - Country:US
Mailing Address - Phone:651-303-3377
Mailing Address - Fax:
Practice Address - Street 1:4339 WOODLAWN PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-4344
Practice Address - Country:US
Practice Address - Phone:651-303-3377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician