=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043499718
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAKE MILLS AREA SCHOOL DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/30/2007
-----------------------------------------------------
Last Update Date | 10/30/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 E LAKE PARK PL
-----------------------------------------------------
City | LAKE MILLS
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53551-1531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-648-2474
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 120 E LAKE PARK PL
-----------------------------------------------------
City | LAKE MILLS
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53551-1531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-648-2474
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF PUPIL SERVICES
-----------------------------------------------------
Name | ELIZABETH A. DOHRN
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 920-648-2474
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------