Provider Demographics
NPI:1316191471
Name:DYNAMIC INTERVENTIONS OF ARIZONA, LLC
Entity Type:Organization
Organization Name:DYNAMIC INTERVENTIONS OF ARIZONA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:BOLAR
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:928-226-1563
Mailing Address - Street 1:2532 N 4TH ST # 481
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-3712
Mailing Address - Country:US
Mailing Address - Phone:928-226-1563
Mailing Address - Fax:928-597-5180
Practice Address - Street 1:4995 US HIGHWAY 68
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86413-5500
Practice Address - Country:US
Practice Address - Phone:928-707-2416
Practice Address - Fax:928-597-5180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-14
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty