Provider Demographics
NPI:1598952079
Name:DYSART UNIFIED SCHOOL DISTRICT
Entity Type:Organization
Organization Name:DYSART UNIFIED SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SCHOL PSYCHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ROXANE
Authorized Official - Middle Name:
Authorized Official - Last Name:KUNZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:623-523-8300
Mailing Address - Street 1:22610 N LAS BRIZAS LN
Mailing Address - Street 2:
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-2829
Mailing Address - Country:US
Mailing Address - Phone:623-214-6950
Mailing Address - Fax:
Practice Address - Street 1:11405 N DYSART RD
Practice Address - Street 2:
Practice Address - City:EL MIRAGE
Practice Address - State:AZ
Practice Address - Zip Code:85335-9233
Practice Address - Country:US
Practice Address - Phone:623-523-8300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ554726Medicare PIN