Provider Demographics
NPI:1679044465
Name:SAVAGE, KEISHA (LISW)
Entity type:Individual
Prefix:
First Name:KEISHA
Middle Name:
Last Name:SAVAGE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3279 INDIANOLA AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1364
Mailing Address - Country:US
Mailing Address - Phone:614-905-7966
Mailing Address - Fax:614-573-0534
Practice Address - Street 1:470 W BROAD ST # 1150
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-2759
Practice Address - Country:US
Practice Address - Phone:614-905-7966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-06
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
OHI.1800860-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical