Healthcare Provider Details

I. General information

NPI: 1831242445
Provider Name (Legal Business Name): DYSART UNIFIED SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13700 W GREENWAY RD
SURPRISE AZ
85374-5291
US

IV. Provider business mailing address

9462 N 94TH LN
PEORIA AZ
85345-6370
US

V. Phone/Fax

Practice location:
  • Phone: 623-876-7706
  • Fax:
Mailing address:
  • Phone: 623-734-4477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number#SLP4009
License Number StateAZ

VIII. Authorized Official

Name: TERESA M CHACE
Title or Position: SPEECH PATHOLOGIST
Credential:
Phone: 623-876-7706