Healthcare Provider Details

I. General information

NPI: 1861653313
Provider Name (Legal Business Name): LYNDEN SCHOOL DISTRICT 504
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 S BRITISH COLUMBIA AVE
LYNDEN WA
98264-2053
US

IV. Provider business mailing address

1203 BRADLEY RD
LYNDEN WA
98264-9514
US

V. Phone/Fax

Practice location:
  • Phone: 360-354-2893
  • Fax:
Mailing address:
  • Phone: 360-354-4443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: STEVE DAHL
Title or Position: SPECIAL PROGRAMS DIRECTOR
Credential:
Phone: 360-354-2893