Healthcare Provider Details

I. General information

NPI: 1851458806
Provider Name (Legal Business Name): INDEPENDENT SCHOOL DISTRICT #885
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 10/22/2021
Certification Date: 10/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11343 50TH STREET NE
ALBERTVILLE MN
55301
US

IV. Provider business mailing address

11343 50TH STREET NE
ALBERTVILLE MN
55301
US

V. Phone/Fax

Practice location:
  • Phone: 763-497-3180
  • Fax: 763-497-6588
Mailing address:
  • Phone: 763-497-3180
  • Fax: 763-497-6588

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: KRISTIN CROCKER
Title or Position: DIRECTOR OF BUSINESS SERVICE
Credential:
Phone: 763-497-3180