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General NPI Number Information
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NPI Number | 1033307145
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Entity Type | Organization
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Legal Business Name | ILLINOIS SCHOOL FOR THE VISUALLY IMPAIRED
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Dates
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Enumeration Date | 10/15/2007
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Last Update Date | 10/15/2007
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Provider Practice Location Address
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Address Line | 658 E STATE ST
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City | JACKSONVILLE
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State | IL
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Zip | 62650-2130
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Country | US
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Telephone | 217-479-4400
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Fax |
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Provider Business Mailing Address
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Address Line | 400 W LAWRENCE AVE
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City | SPRINGFIELD
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State | IL
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Zip | 62704-2625
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Country | US
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Telephone | 217-524-4089
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Fax | 217-524-2352
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Authorized Official
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Title or Position | ACTING SUPERINTENDENT
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Name | JOAN FORNEY
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Credential |
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Telephone | 217-479-4400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number |
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License Number State |
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