Provider Demographics
NPI:1053913715
Name:SALIZZONI, GLORY M (ADMINISTRATOR)
Entity type:Individual
Prefix:MRS
First Name:GLORY
Middle Name:M
Last Name:SALIZZONI
Suffix:
Gender:F
Credentials:ADMINISTRATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2304 W OLIVE WAY
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-4165
Mailing Address - Country:US
Mailing Address - Phone:623-298-7721
Mailing Address - Fax:
Practice Address - Street 1:8517 S 55TH DR
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-5224
Practice Address - Country:US
Practice Address - Phone:623-298-7721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health