Healthcare Provider Details

I. General information

NPI: 1437339306
Provider Name (Legal Business Name): EDUCATIONAL SERVICE DISTRICT 123
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2007
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3918 W COURT ST
PASCO WA
99301-2775
US

IV. Provider business mailing address

3924 W COURT ST
PASCO WA
99301-2775
US

V. Phone/Fax

Practice location:
  • Phone: 509-544-5761
  • Fax: 509-543-3328
Mailing address:
  • Phone: 509-544-5761
  • Fax: 509-543-3328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number11135800
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DIANE LOIS SHEPHERD
Title or Position: PREVENTION & TREATMENT CENTER DIREC
Credential: CDP
Phone: 509-544-5761