Provider Demographics
NPI:1265976195
Name:POLIZZI FOUNDATION
Entity type:Organization
Organization Name:POLIZZI FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:KOCIOLEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-590-9557
Mailing Address - Street 1:515 E 4500 S
Mailing Address - Street 2:SUITE G220
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-4500
Mailing Address - Country:US
Mailing Address - Phone:801-590-9557
Mailing Address - Fax:801-590-5997
Practice Address - Street 1:515 E 4500 S
Practice Address - Street 2:SUITE G220
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-4500
Practice Address - Country:US
Practice Address - Phone:801-590-9557
Practice Address - Fax:801-590-9957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-12
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT178852-1205103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty