Provider Demographics
NPI:1033395769
Name:NAU IHD ASSISTIVE TECHNOLOGY CENTER
Entity Type:Organization
Organization Name:NAU IHD ASSISTIVE TECHNOLOGY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OFFICE OF GRANT AND CONTRA
Authorized Official - Prefix:MS
Authorized Official - First Name:WILMA
Authorized Official - Middle Name:G
Authorized Official - Last Name:ENNENGA
Authorized Official - Suffix:
Authorized Official - Credentials:BA MA ABD
Authorized Official - Phone:928-523-4880
Mailing Address - Street 1:BOX 5630
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86011-5630
Mailing Address - Country:US
Mailing Address - Phone:928-523-5878
Mailing Address - Fax:928-523-4953
Practice Address - Street 1:BUILDING 27A RIORDAN ROAD
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001
Practice Address - Country:US
Practice Address - Phone:928-523-5878
Practice Address - Fax:928-523-4953
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARIZONA BOARD OF REGENTS FOR AND ON BEHALF OF NORTHERN ARIZONA UNIVERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-11
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ725806Medicaid