Healthcare Provider Details

I. General information

NPI: 1962627455
Provider Name (Legal Business Name): SEYMOUR COMMUNITY SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CIRCLE DR
SEYMOUR WI
54165-1678
US

IV. Provider business mailing address

10 CIRCLE DR
SEYMOUR WI
54165-1678
US

V. Phone/Fax

Practice location:
  • Phone: 920-833-7199
  • Fax: 920-833-9376
Mailing address:
  • Phone: 920-833-7199
  • Fax: 920-833-9376

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: MR. PATRICK KLASS
Title or Position: DIRECTOR OF PUPIL SERVICES
Credential:
Phone: 920-833-7199