=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093994725
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WASHBURN SCHOOL DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/30/2007
-----------------------------------------------------
Last Update Date | 10/30/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 305 W 4TH ST
-----------------------------------------------------
City | WASHBURN
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54891-5407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-373-6199
-----------------------------------------------------
Fax | 715-373-0586
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 730
-----------------------------------------------------
City | WASHBURN
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54891-0730
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-373-6199
-----------------------------------------------------
Fax | 715-373-0586
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DISTRICT ADMINISTRATOR
-----------------------------------------------------
Name | SUSAN MASTERSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 715-373-6199
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------