Healthcare Provider Details

I. General information

NPI: 1063652477
Provider Name (Legal Business Name): SHANNON COUNTY SCHOOLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2009
Last Update Date: 02/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 SCHOOL ST.
BATESLAND SD
57716-0109
US

IV. Provider business mailing address

PO BOX 109
BATESLAND SD
57716-0109
US

V. Phone/Fax

Practice location:
  • Phone: 605-288-1921
  • Fax: 605-288-1814
Mailing address:
  • Phone: 605-288-1921
  • Fax: 605-288-1814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
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

VIII. Authorized Official

Name: MRS. MADONNA PETERSON
Title or Position: BUSINESS MANAGER
Credential:
Phone: 605-288-1921