Provider Demographics
NPI:1578003943
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:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:SPL-CCC
Authorized Official - Phone:928-226-1563
Mailing Address - Street 1:8495 ARROYO TRL
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-6231
Mailing Address - Country:US
Mailing Address - Phone:928-856-2244
Mailing Address - Fax:
Practice Address - Street 1:1805 W HEAVENLY CT
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-2836
Practice Address - Country:US
Practice Address - Phone:928-226-1563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-03
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA104872355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Multi-Specialty