Healthcare Provider Details

I. General information

NPI: 1649289117
Provider Name (Legal Business Name): SOUTH WHIDBEY SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 CAMANO AVENUE
LANGLEY WA
98260-0346
US

IV. Provider business mailing address

721 CAMANO AVENUE PO BOX 346
LANGLEY WA
98260-0346
US

V. Phone/Fax

Practice location:
  • Phone: 360-221-6100
  • Fax: 360-221-3835
Mailing address:
  • Phone: 360-221-6100
  • Fax: 360-221-3835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DIANE WATSON
Title or Position: DIRECTOR OF STUDENT SUPPORT
Credential:
Phone: 360-221-6100