Provider Demographics
NPI:1003122847
Name:AGUA FRIA UNION HIGH SCHOOL DIST #216
Entity Type:Organization
Organization Name:AGUA FRIA UNION HIGH SCHOOL DIST #216
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MIPS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LUPE
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGOVIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-932-7141
Mailing Address - Street 1:1481 N ELISEO FELIX JR WAY
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-1216
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1481 N ELISEO FELIX JR WAY
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-1216
Practice Address - Country:US
Practice Address - Phone:623-932-7141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP4856235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty