MEDICARE: ARIZONA STATE UNIVERSITY

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	231H00000X	Audiologist

General Provider Information

NPI Number	:	1952338865
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARIZONA STATE UNIVERSITY

Provider Business Mailing Address
First Line	:	COOR HALL 2211
Second Line	:	PO BOX 870102
City	:	TEMPE
State	:	AZ
Zip	:	85287-0102
Country	:	US
Telephone Number	:	480-965-2373
Fax Number	:	480-965-0076

Provider Business Practice Location Address
First Line	:	COOR HALL 2211
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85287-0102
Country	:	US
Telephone Number	:	480-965-2373
Fax Number	:	480-965-0076

Authorized Official
Title or Position	:	DIRECTOR OF AUDIOLOGY
Name	:	DR. INGRID KRISTINA MCBRIDE
Credential	:	AU.D.
Telephone Number	:	480-965-0614

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	08/22/2020

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