Provider Demographics
NPI:1306402599
Name:TOSCANO, PRISCILLA
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
Last Name:TOSCANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 W 1900 N
Mailing Address - Street 2:
Mailing Address - City:SUNSET
Mailing Address - State:UT
Mailing Address - Zip Code:84015-2618
Mailing Address - Country:US
Mailing Address - Phone:801-915-7799
Mailing Address - Fax:801-513-5608
Practice Address - Street 1:107 W 1900 N
Practice Address - Street 2:
Practice Address - City:SUNSET
Practice Address - State:UT
Practice Address - Zip Code:84015-2618
Practice Address - Country:US
Practice Address - Phone:801-915-7799
Practice Address - Fax:801-513-5608
Is Sole Proprietor?:No
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician