Healthcare Provider Details

I. General information

NPI: 1396869590
Provider Name (Legal Business Name): BENJAMIN SCHOOL DISTRICT 25
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28W250 SAINT CHARLES RD
WEST CHICAGO IL
60185-1454
US

IV. Provider business mailing address

28W250 SAINT CHARLES RD
WEST CHICAGO IL
60185-1454
US

V. Phone/Fax

Practice location:
  • Phone: 630-876-7800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. LARRY WECK
Title or Position: SUPERINTENDENT
Credential:
Phone: 630-876-7800