Provider Demographics
NPI:1013247998
Name:JADE, SAVOY ROSE (LCSW, LMT)
Entity Type:Individual
Prefix:
First Name:SAVOY
Middle Name:ROSE
Last Name:JADE
Suffix:
Gender:F
Credentials:LCSW, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2104
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-0152
Mailing Address - Country:US
Mailing Address - Phone:541-961-8423
Mailing Address - Fax:541-265-9852
Practice Address - Street 1:1642 N COAST HWY
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-2357
Practice Address - Country:US
Practice Address - Phone:541-961-8423
Practice Address - Fax:541-265-9852
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-28
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14673225700000X
ORL61091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist