Provider Demographics
NPI:1346092517
Name:SIX, SAVANAH
Entity Type:Individual
Prefix:
First Name:SAVANAH
Middle Name:
Last Name:SIX
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 1:4TH ST. UNIT 1
Mailing Address - Street 2:
Mailing Address - City:HOUCK
Mailing Address - State:AZ
Mailing Address - Zip Code:86506
Mailing Address - Country:US
Mailing Address - Phone:480-766-6880
Mailing Address - Fax:
Practice Address - Street 1:2105 HASLER VALLEY RD.
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301
Practice Address - Country:US
Practice Address - Phone:505-413-3447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker