Healthcare Provider Details

I. General information

NPI: 1699969840
Provider Name (Legal Business Name): MEQUON-THIENSVILLE SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2007
Last Update Date: 08/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 W MEQUON RD
MEQUON WI
53092-2044
US

IV. Provider business mailing address

5000 W MEQUON RD
MEQUON WI
53092-2044
US

V. Phone/Fax

Practice location:
  • Phone: 262-238-8501
  • Fax: 262-238-8520
Mailing address:
  • Phone: 262-238-8501
  • Fax: 262-238-8520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347B00000X
TaxonomyBus
License Number
License Number StateWI

VIII. Authorized Official

Name: MR. DENNIS JOYCE
Title or Position: DIRECTOR OF PUPIL SERVICES
Credential:
Phone: 262-238-8501