Provider Demographics
NPI:1427405380
Name:STILES, SAVANAH
Entity Type:Individual
Prefix:
First Name:SAVANAH
Middle Name:
Last Name:STILES
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 1:151 W MONTGOMERY AVE
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-4049
Mailing Address - Country:US
Mailing Address - Phone:812-886-3000
Mailing Address - Fax:812-886-3010
Practice Address - Street 1:2290 S THEOBALD LN
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-8027
Practice Address - Country:US
Practice Address - Phone:812-886-3000
Practice Address - Fax:812-886-3000
Is Sole Proprietor?:No
Enumeration Date:2016-05-20
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33007453A104100000X
IN34007988A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker