MEDICARE: DELAVAN CUSD 703

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)

General Provider Information

NPI Number	:	1427250984
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DELAVAN CUSD 703

Provider Business Mailing Address
First Line	:	907 LOCUST ST
Second Line	:
City	:	DELAVAN
State	:	IL
Zip	:	61734-9231
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	907 LOCUST ST
Second Line	:
City	:	DELAVAN
State	:	IL
Zip	:	61734-9231
Country	:	US
Telephone Number	:	309-347-5167
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	SALLY MASEAR
Credential	:
Telephone Number	:	309-347-5167

Provider Enumeration Date	:	06/05/2007
Last Update Date	:	08/22/2020

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