Provider Demographics
NPI:1053953950
Name:BAYLESS, SAVANNA (BA)
Entity type:Individual
Prefix:
First Name:SAVANNA
Middle Name:
Last Name:BAYLESS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 HIGHLAND WAY
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-5823
Mailing Address - Country:US
Mailing Address - Phone:307-371-7904
Mailing Address - Fax:
Practice Address - Street 1:79 WINSTON DR STE 235
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-5770
Practice Address - Country:US
Practice Address - Phone:307-922-2908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator