=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295964658
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTHWEST EDUCATION SERVICE DISTRICT 189
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2009
-----------------------------------------------------
Last Update Date | 12/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1601 R AVENUE
-----------------------------------------------------
City | ANACORTES
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98221-2276
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-299-4000
-----------------------------------------------------
Fax | 360-299-4004
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1601 R AVENUE
-----------------------------------------------------
City | ANACORTES
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98221-2276
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-299-4000
-----------------------------------------------------
Fax | 360-299-4004
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SUPERINTENDENT
-----------------------------------------------------
Name | ISMAEL VIVANCO
-----------------------------------------------------
Credential | ED. D.
-----------------------------------------------------
Telephone | 360-299-4003
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number | 29 1439 00
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------