Provider Demographics
NPI:1053976555
Name:COLOMBO, GIOVANNA ELIANA (CASUDC)
Entity type:Individual
Prefix:
First Name:GIOVANNA
Middle Name:ELIANA
Last Name:COLOMBO
Suffix:
Gender:F
Credentials:CASUDC
Other - Prefix:
Other - First Name:GIOVANNA
Other - Middle Name:ELIANA
Other - Last Name:COLOMBO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CASUDC
Mailing Address - Street 1:164 E 5900 S
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-7256
Mailing Address - Country:US
Mailing Address - Phone:801-261-5790
Mailing Address - Fax:801-261-5794
Practice Address - Street 1:164 E 5900 S
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-7256
Practice Address - Country:US
Practice Address - Phone:801-261-5790
Practice Address - Fax:801-261-5794
Is Sole Proprietor?:No
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9722429-6018101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)