Provider Demographics
NPI:1093910762
Name:UNIVERSITY OF NORTH DAKOTA
Entity Type:Organization
Organization Name:UNIVERSITY OF NORTH DAKOTA
Other - Org Name:UND SPEECH LANGUAGE & HEARING CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEPARTMENT CHAIR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:MADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:701-777-3232
Mailing Address - Street 1:290 CENTENNIAL DR STOP 8040
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58202-8040
Mailing Address - Country:US
Mailing Address - Phone:701-777-3232
Mailing Address - Fax:
Practice Address - Street 1:290 CENTENNIAL DR
Practice Address - Street 2:MONTGOMERY HALL ROOM 101
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58202-6063
Practice Address - Country:US
Practice Address - Phone:701-777-3727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF NORTH DAKOTA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-20
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND50055Medicaid