Healthcare Provider Details

I. General information

NPI: 1831388370
Provider Name (Legal Business Name): CEDARBURG SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2007
Last Update Date: 10/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W68N611 EVERGREEN BLVD
CEDARBURG WI
53012-1847
US

IV. Provider business mailing address

W68N611 EVERGREEN BLVD
CEDARBURG WI
53012-1847
US

V. Phone/Fax

Practice location:
  • Phone: 262-376-6140
  • Fax: 262-376-6150
Mailing address:
  • Phone: 262-376-6140
  • Fax: 262-376-6150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number60217800
License Number StateWI

VIII. Authorized Official

Name: MRS. JAN CHAPMAN
Title or Position: DIRECTOR PUPIL SERVICES
Credential:
Phone: 262-376-6140