Provider Demographics
NPI:1669647343
Name:CHILDYNAMICS, LLC HEALTH CHECK SERVICES
Entity Type:Organization
Organization Name:CHILDYNAMICS, LLC HEALTH CHECK SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHD
Authorized Official - Prefix:
Authorized Official - First Name:ISABELA
Authorized Official - Middle Name:
Authorized Official - Last Name:SARDAS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:414-258-4318
Mailing Address - Street 1:11904 W NORTH AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-2062
Mailing Address - Country:US
Mailing Address - Phone:414-258-4318
Mailing Address - Fax:
Practice Address - Street 1:11904 W NORTH AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-2062
Practice Address - Country:US
Practice Address - Phone:414-258-4318
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41872700Medicaid