Healthcare Provider Details

I. General information

NPI: 1760546717
Provider Name (Legal Business Name): GRANT WOOD AEA 10
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 6TH ST SW
CEDAR RAPIDS IA
52404-4432
US

IV. Provider business mailing address

4401 6TH ST SW
CEDAR RAPIDS IA
52404-4432
US

V. Phone/Fax

Practice location:
  • Phone: 319-399-6700
  • Fax: 319-399-6457
Mailing address:
  • Phone: 319-399-6700
  • Fax: 319-399-6457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0051763
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name: MARIA CASHMAN
Title or Position: DIRECTOR OF SPECIAL EDUCATION
Credential:
Phone: 319-399-6700