Provider Demographics
NPI:1912397001
Name:INTERNATIONAL DIAGNOSTIC SOLUTIONS
Entity Type:Organization
Organization Name:INTERNATIONAL DIAGNOSTIC SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COFOUNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, MPH
Authorized Official - Phone:202-202-6537
Mailing Address - Street 1:641 S ST NW FL 3
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-5196
Mailing Address - Country:US
Mailing Address - Phone:202-262-6537
Mailing Address - Fax:
Practice Address - Street 1:641 S ST NW
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-5131
Practice Address - Country:US
Practice Address - Phone:202-643-7462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-28
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty