Provider Demographics
NPI:1013655653
Name:ZIZUMBO, VICTOR SAMUEL (CSW)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:SAMUEL
Last Name:ZIZUMBO
Suffix:
Gender:M
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3280 S HUNTER FARM WAY
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84128-1143
Mailing Address - Country:US
Mailing Address - Phone:801-628-2169
Mailing Address - Fax:
Practice Address - Street 1:255 N 400 W
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-1112
Practice Address - Country:US
Practice Address - Phone:801-382-8259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5505673-35061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical