Healthcare Provider Details

I. General information

NPI: 1578583019
Provider Name (Legal Business Name): UNIFIED SCHOOL DISTRICT 405
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S WORKMAN ST
LYONS KS
67554-3629
US

IV. Provider business mailing address

PO BOX 189
GIRARD KS
66743-0189
US

V. Phone/Fax

Practice location:
  • Phone: 620-257-5196
  • Fax: 620-257-5197
Mailing address:
  • Phone: 888-654-8701
  • Fax: 620-724-7141

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: MR. GREGORY ALLEN KONDA
Title or Position: SPECIAL EDUCATION COORDINATOR
Credential:
Phone: 620-257-5196