Healthcare Provider Details

I. General information

NPI: 1093560732
Provider Name (Legal Business Name): GREGORY DALESSIO III
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2024
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 30995
SALT LAKE CITY UT
84130-0995
US

IV. Provider business mailing address

PO BOX 30995
SALT LAKE CITY UT
84130-0995
US

V. Phone/Fax

Practice location:
  • Phone: 800-633-4227
  • Fax:
Mailing address:
  • Phone: 800-633-4227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: