Provider Demographics
NPI:1659172187
Name:KEOWN, SAVANNAH MARIE
Entity type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:MARIE
Last Name:KEOWN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:SAVANNAH
Other - Middle Name:MARIE
Other - Last Name:KEOWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:178 CALDWELL AVE
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-2720
Mailing Address - Country:US
Mailing Address - Phone:502-350-7788
Mailing Address - Fax:
Practice Address - Street 1:178 CALDWELL AVE
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-2720
Practice Address - Country:US
Practice Address - Phone:502-350-7788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician