Provider Demographics
NPI:1164530796
Name:ABILENE CHRISTIAN UNIVERSITY
Entity Type:Organization
Organization Name:ABILENE CHRISTIAN UNIVERSITY
Other - Org Name:CENTER FOR SPEECH AND LANGUAGE DISORDERS AT ACU
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEPARTMENT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-674-2074
Mailing Address - Street 1:1600 CAMPUS CT
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79699-0001
Mailing Address - Country:US
Mailing Address - Phone:325-674-2074
Mailing Address - Fax:325-674-2552
Practice Address - Street 1:ACU BOX 28058
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79699-0001
Practice Address - Country:US
Practice Address - Phone:325-674-2074
Practice Address - Fax:325-674-2552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2007-08-24
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
TX676606Medicare ID - Type UnspecifiedPROVIDER NUMBER