Healthcare Provider Details

I. General information

NPI: 1568526424
Provider Name (Legal Business Name): COUNTY OF CARLTON/WRENSHALL ISD #100
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 10/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 14TH ST
CLOQUET MN
55720-2102
US

IV. Provider business mailing address

302 14TH ST
CLOQUET MN
55720-2102
US

V. Phone/Fax

Practice location:
  • Phone: 218-879-1283
  • Fax: 218-879-1285
Mailing address:
  • Phone: 218-879-1283
  • Fax: 218-879-1285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GERI FERNJACK
Title or Position: OFFICE ASSISTANT RECEPTIONIST
Credential:
Phone: 218-879-1283