Healthcare Provider Details

I. General information

NPI: 1679427694
Provider Name (Legal Business Name): CLEARWATER VALLEY SCHOOL DISTRICT #245
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4643 HIGHWAY 13
KOOSKIA ID
83539-5062
US

IV. Provider business mailing address

4643 HIGHWAY 13
KOOSKIA ID
83539-5062
US

V. Phone/Fax

Practice location:
  • Phone: 208-926-4511
  • Fax:
Mailing address:
  • Phone: 208-926-4511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHARLOTTE MCKINNEY
Title or Position: DIRECTOR SPECIAL EDUCATION
Credential: MED
Phone: 208-926-4511