Provider Demographics
NPI:1912950486
Name:NORTHERN ARIZONA UNIVERSITY
Entity Type:Organization
Organization Name:NORTHERN ARIZONA UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS ASSISTANT MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGEE
Authorized Official - Suffix:
Authorized Official - Credentials:BSW
Authorized Official - Phone:928-523-7776
Mailing Address - Street 1:208 E PINE KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86011-0001
Mailing Address - Country:US
Mailing Address - Phone:928-523-8110
Mailing Address - Fax:928-523-0034
Practice Address - Street 1:208 E PINE KNOLL DR
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86011-0001
Practice Address - Country:US
Practice Address - Phone:928-523-8110
Practice Address - Fax:928-523-0034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA1859237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ73149Medicare UPIN