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General NPI Number Information
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NPI Number | 1144315599
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Entity Type | Organization
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Legal Business Name | SOUTHSIDE SCHOOL DISTRICT
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 700 SOUTH FIRST STREET C/O SHELTON-MASON COUNTY COOP
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City | SHELTON
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State | WA
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Zip | 98584
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Country | US
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Telephone | 360-426-2151
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Fax | 360-426-9727
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Provider Business Mailing Address
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Address Line | 700 SOUTH FIRST STREET C/O SHELTON-MASON COUNTY COOP
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City | SHELTON
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State | WA
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Zip | 98584
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Country | US
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Telephone | 360-426-2151
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Fax | 360-426-9727
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Authorized Official
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Title or Position | DIRECTOR OF SPECIAL SERVICES
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Name | MR. EDWARD D BORN
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Credential |
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Telephone | 360-426-2151
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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 | WA
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