=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073771341
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ITHACA SCHOOL DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2008
-----------------------------------------------------
Last Update Date | 05/23/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24615 STATE HWY 58
-----------------------------------------------------
City | RICHLAND CENTER
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53581-6642
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-585-2512
-----------------------------------------------------
Fax | 608-585-2505
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24615 STATE HWY 58
-----------------------------------------------------
City | RICHLAND CENTER
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53581-6642
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-585-2512
-----------------------------------------------------
Fax | 608-585-2505
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DISTRICT ADMINISTRATOR
-----------------------------------------------------
Name | JENNIFER VOGLER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 608-585-2512
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number | 4422520
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------