=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144494923
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRAIRIE DU CHIEN AREA SCHOOL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/14/2008
-----------------------------------------------------
Last Update Date | 04/14/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 420 S WACOUTA AVE
-----------------------------------------------------
City | PRAIRIE DU CHIEN
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53821-1924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-326-8451
-----------------------------------------------------
Fax | 608-326-0000
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 420 S WACOUTA AVE
-----------------------------------------------------
City | PRAIRIE DU CHIEN
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53821-1924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DISTRICT BOOKKEEPER
-----------------------------------------------------
Name | VICKI WALLER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 608-326-8451
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QS1000X
-----------------------------------------------------
Taxonomy Name | Student Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------