Provider Demographics
NPI:1053744573
Name:SAVAGE, JADE ALISHA
Entity type:Individual
Prefix:MRS
First Name:JADE
Middle Name:ALISHA
Last Name:SAVAGE
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JADE
Other - Middle Name:ALISHA
Other - Last Name:HORRIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3175 S 2000 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-2459
Mailing Address - Country:US
Mailing Address - Phone:720-771-9945
Mailing Address - Fax:
Practice Address - Street 1:3175 S 2000 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84109-2459
Practice Address - Country:US
Practice Address - Phone:720-771-9945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator