Healthcare Provider Details

I. General information

NPI: 1710166277
Provider Name (Legal Business Name): PLYMOUTH JOINT SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2007
Last Update Date: 10/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 S HIGHLAND AVE
PLYMOUTH WI
53073-2566
US

IV. Provider business mailing address

125 S HIGHLAND AVE
PLYMOUTH WI
53073-2566
US

V. Phone/Fax

Practice location:
  • Phone: 920-892-5022
  • Fax: 920-892-5078
Mailing address:
  • Phone: 920-892-5022
  • Fax: 920-892-5078

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: ANNE GAMOKE
Title or Position: PUPIL SERVICES DIRECTOR
Credential:
Phone: 920-892-5022