MEDICARE: MAPLE DALE - INDIAN HILL SCHOOL DISTRICT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)		WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225253859
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAPLE DALE - INDIAN HILL SCHOOL DISTRICT

Provider Business Mailing Address
First Line	:	2600 W MILL RD
Second Line	:
City	:	GLENDALE
State	:	WI
Zip	:	53209-3212
Country	:	US
Telephone Number	:	414-351-7170
Fax Number	:	414-434-0109

Provider Business Practice Location Address
First Line	:	2600 W MILL RD
Second Line	:
City	:	GLENDALE
State	:	WI
Zip	:	53209-3212
Country	:	US
Telephone Number	:	414-351-7170
Fax Number	:	414-434-0109

Authorized Official
Title or Position	:	DIRECTOR OF SPEC. ED PUPIL SERVICES
Name	:	MS. DEB COOK-WESTFAHL
Credential	:
Telephone Number	:	414-351-7170

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	08/22/2020

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