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General NPI Number Information
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NPI Number | 1003122847
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Entity Type | Organization
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Legal Business Name | AGUA FRIA UNION HIGH SCHOOL DIST #216
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Dates
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Enumeration Date | 08/30/2010
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Last Update Date | 08/30/2010
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Provider Practice Location Address
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Address Line | 1481 N ELISEO FELIX JR WAY
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City | AVONDALE
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State | AZ
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Zip | 85323-1216
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Country | US
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Telephone | 623-932-7141
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Fax |
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Provider Business Mailing Address
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Address Line | 1481 N ELISEO FELIX JR WAY
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City | AVONDALE
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State | AZ
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Zip | 85323-1216
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MIPS COORDINATOR
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Name | LUPE SEGOVIA
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Credential |
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Telephone | 623-932-7141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SLP4856
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License Number State | AZ
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