MEDICARE: MINNETONKA PUBLIC SCHOOLS

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)		MN

General Provider Information

NPI Number	:	1285911750
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINNETONKA PUBLIC SCHOOLS

Provider Business Mailing Address
First Line	:	5621 COUNTY ROAD 101
Second Line	:
City	:	MINNETONKA
State	:	MN
Zip	:	55345-4214
Country	:	US
Telephone Number	:	952-401-5017
Fax Number	:	952-401-5032

Provider Business Practice Location Address
First Line	:	5621 COUNTY ROAD 101
Second Line	:
City	:	MINNETONKA
State	:	MN
Zip	:	55345-4214
Country	:	US
Telephone Number	:	952-401-5017
Fax Number	:	952-401-5032

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR OF STUDENT SUPPO
Name	:	DR. JAN R BOOTSMA
Credential	:	PH.D.
Telephone Number	:	952-401-5017

Provider Enumeration Date	:	11/10/2011
Last Update Date	:	11/10/2011

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Directions to “MINNETONKA PUBLIC SCHOOLS ” Practice Location

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