Provider Demographics
NPI:1164660908
Name:INFANT CHILD RESEARCH PROGRAM
Entity Type:Organization
Organization Name:INFANT CHILD RESEARCH PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-965-9396
Mailing Address - Street 1:INFANT CHILD RESEARCH PROGRAM AT ASU
Mailing Address - Street 2:PO BOX 871908
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85287-0001
Mailing Address - Country:US
Mailing Address - Phone:480-965-9396
Mailing Address - Fax:480-965-0965
Practice Address - Street 1:INFANT CHILD RESEARCH PROGRAM AT ASU
Practice Address - Street 2:200 E. CURRY ROAD
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85287-0001
Practice Address - Country:US
Practice Address - Phone:480-965-9396
Practice Address - Fax:480-965-0965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency