Provider Demographics
NPI:1437278785
Name:VANZANT, ALLISON (FP)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:VANZANT
Suffix:
Gender:F
Credentials:FP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20702 W GRANT MINE RD
Mailing Address - Street 2:
Mailing Address - City:WITTMANN
Mailing Address - State:AZ
Mailing Address - Zip Code:85361-9778
Mailing Address - Country:US
Mailing Address - Phone:623-810-0725
Mailing Address - Fax:
Practice Address - Street 1:20702 W GRANT MINE RD
Practice Address - Street 2:
Practice Address - City:WITTMANN
Practice Address - State:AZ
Practice Address - Zip Code:85361-9778
Practice Address - Country:US
Practice Address - Phone:623-810-0725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ104942Medicaid