Healthcare Provider Details

I. General information

NPI: 1629260328
Provider Name (Legal Business Name): ROOSEVELTSCHOOLDISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 S 7TH AVE
PHOENIX AZ
85041-4015
US

IV. Provider business mailing address

5401 S 7TH AVE
PHOENIX AZ
85041-4015
US

V. Phone/Fax

Practice location:
  • Phone: 602-232-4960
  • Fax:
Mailing address:
  • Phone: 602-232-4960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number0
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number0
License Number StateAZ

VIII. Authorized Official

Name: MS. BARBARAJ J ZIERDEN
Title or Position: SCHOOL NURSE
Credential: RN
Phone: 602-232-4960