Healthcare Provider Details

I. General information

NPI: 1821262478
Provider Name (Legal Business Name): SCHOOL DISTRICT R 1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2008
Last Update Date: 06/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 BURLINGTON ST
WELLSVILLE MO
63384-1114
US

IV. Provider business mailing address

900 BURLINGTON ST
WELLSVILLE MO
63384-1114
US

V. Phone/Fax

Practice location:
  • Phone: 573-684-2071
  • Fax: 573-684-2018
Mailing address:
  • Phone: 573-684-2071
  • Fax: 573-684-2018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY GOSSEEN
Title or Position: DIRECTOR OF SPECIAL EDUCATION
Credential:
Phone: 573-684-2071