Provider Demographics
NPI:1891479804
Name:STIDHAMS, SAVANNAH MARIE (MA)
Entity Type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:MARIE
Last Name:STIDHAMS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19725 76TH AVE W APT 6B
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-5826
Mailing Address - Country:US
Mailing Address - Phone:425-327-6235
Mailing Address - Fax:
Practice Address - Street 1:4030 LAKE WASHINGTON BLVD NE STE 201
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-7870
Practice Address - Country:US
Practice Address - Phone:206-414-8918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health