Healthcare Provider Details

I. General information

NPI: 1891960423
Provider Name (Legal Business Name): NORTHWESTERN SCHOOL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 04/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3075 N WASHINGTON ST
KOKOMO IN
46901-5857
US

IV. Provider business mailing address

3075 N WASHINGTON ST
KOKOMO IN
46901-5857
US

V. Phone/Fax

Practice location:
  • Phone: 765-452-3060
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347B00000X
TaxonomyBus
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MR. RYAN SNODDY
Title or Position: SUPERINTENDENT
Credential: ED.S.
Phone: 765-452-3060