MEDICARE: CHILDYNAMICS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235304692
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDYNAMICS LLC

Provider Business Mailing Address
First Line	:	11904 W NORTH AVE
Second Line	:	SUITE 110
City	:	WAUWATOSA
State	:	WI
Zip	:	53226-2062
Country	:	US
Telephone Number	:	414-258-4318
Fax Number	:

Provider Business Practice Location Address
First Line	:	11904 W NORTH AVE
Second Line	:	SUITE 110
City	:	WAUWATOSA
State	:	WI
Zip	:	53226-2062
Country	:	US
Telephone Number	:	414-258-4318
Fax Number	:

Authorized Official
Title or Position	:	PHD
Name	:	DR. ISABELA SARDAS
Credential	:	PHD
Telephone Number	:	414-258-4318

Provider Enumeration Date	:	04/28/2008
Last Update Date	:	04/28/2008

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Directions to “CHILDYNAMICS LLC ” Practice Location

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