Healthcare Provider Details

I. General information

NPI: 1275778870
Provider Name (Legal Business Name): WHITE LAKE SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2008
Last Update Date: 12/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 SOUTH MAIN ST
PLATTE SD
57369-0228
US

IV. Provider business mailing address

502 EAST DIVISION ST
WHITE LAKE SD
57383-0245
US

V. Phone/Fax

Practice location:
  • Phone: 605-337-2636
  • Fax: 605-337-2271
Mailing address:
  • Phone: 605-249-2251
  • Fax: 605-249-2725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. BERLE JOHNSON
Title or Position: SUPERINTENDENT
Credential:
Phone: 605-249-2251