=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134308760
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SCHOOL DISTRICT OF WABENO AREA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/31/2007
-----------------------------------------------------
Last Update Date | 10/31/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4346 MILL LN
-----------------------------------------------------
City | WABENO
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54566-9264
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-473-2592
-----------------------------------------------------
Fax | 715-473-5201
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 460
-----------------------------------------------------
City | WABENO
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54566-0460
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-473-2592
-----------------------------------------------------
Fax | 715-473-5201
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DISTRICT ADMINISTRATOR
-----------------------------------------------------
Name | MS. KIMBERLY A ODEKIRK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 715-473-2592
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------