Healthcare Provider Details

I. General information

NPI: 1588989685
Provider Name (Legal Business Name): SOUTHERN OREGON EDUCATION SERVICE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2010
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 NW HIGHLAND AVE
GRANTS PASS OR
97526-1146
US

IV. Provider business mailing address

101 N GRAPE ST
MEDFORD OR
97501-2718
US

V. Phone/Fax

Practice location:
  • Phone: 541-956-2059
  • Fax:
Mailing address:
  • Phone: 541-776-8580
  • Fax: 541-779-2018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK ANGLE-HOBSON
Title or Position: DEPUTY CLERK
Credential:
Phone: 541-776-8580