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General NPI Number Information
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NPI Number | 1174650303
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Entity Type | Organization
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Legal Business Name | WISE COUNTY SPECIAL EDUCATION COOPERATIVE
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2105 16TH ST
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City | BRIDGEPORT
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State | TX
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Zip | 76426-2129
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Country | US
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Telephone | 940-683-8361
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Fax | 940-683-1912
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Provider Business Mailing Address
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Address Line | 2105 16TH ST
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City | BRIDGEPORT
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State | TX
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Zip | 76426-2129
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Country | US
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Telephone | 940-683-8361
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Fax | 940-683-1912
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Authorized Official
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Title or Position | PEIMS MEDICAID ESPED COORDINATOR
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Name | DEBORAH ALTHIEA GASTON
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Credential |
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Telephone | 940-683-8361
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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 |
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