Healthcare Provider Details

I. General information

NPI: 1003088824
Provider Name (Legal Business Name): SCHOOL DISTRICT OF LA FARGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W ADAMS ST
LA FARGE WI
54639-7936
US

IV. Provider business mailing address

301 W ADAMS ST
LA FARGE WI
54639-7936
US

V. Phone/Fax

Practice location:
  • Phone: 608-625-0107
  • Fax:
Mailing address:
  • Phone: 608-625-0107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. SHAWN DONOVAN
Title or Position: DISTRICT ADMINISTRATOR
Credential:
Phone: 608-625-0107