Healthcare Provider Details

I. General information

NPI: 1245411305
Provider Name (Legal Business Name): SOUTH WINNESHIEK COMM SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2007
Last Update Date: 11/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 S WEBSTER ST
CALMAR IA
52132-0430
US

IV. Provider business mailing address

PO BOX 430
CALMAR IA
52132-0430
US

V. Phone/Fax

Practice location:
  • Phone: 563-562-3269
  • Fax: 563-562-3260
Mailing address:
  • Phone: 563-562-3269
  • Fax: 563-562-3260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. KAY A DONLAN
Title or Position: BOARD SECRETARY
Credential:
Phone: 563-562-3269