Provider Demographics
NPI:1093560732
Name:DALESSIO, GREGORY III
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:DALESSIO
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30995
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84130-0995
Mailing Address - Country:US
Mailing Address - Phone:800-633-4227
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 30995
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84130-0995
Practice Address - Country:US
Practice Address - Phone:800-633-4227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist