Provider Demographics
NPI:1790821189
Name:SADALLA, JO VICTORY (MSW)
Entity Type:Individual
Prefix:MRS
First Name:JO
Middle Name:VICTORY
Last Name:SADALLA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MISS
Other - First Name:JO
Other - Middle Name:VICTORY
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:301 E BETHANY HOME RD
Mailing Address - Street 2:C 296
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1263
Mailing Address - Country:US
Mailing Address - Phone:602-264-1800
Mailing Address - Fax:602-264-1887
Practice Address - Street 1:301 E BETHANY HOME RD
Practice Address - Street 2:C 296
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1263
Practice Address - Country:US
Practice Address - Phone:602-264-1800
Practice Address - Fax:602-264-1887
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW02161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical