=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326050857
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KENT INTERMEDIATE SCHOOL DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2930 KNAPP ST NE
-----------------------------------------------------
City | GRAND RAPIDS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49525-4518
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-365-2395
-----------------------------------------------------
Fax | 616-365-2336
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2930 KNAPP ST NE
-----------------------------------------------------
City | GRAND RAPIDS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49525-4518
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-365-2395
-----------------------------------------------------
Fax | 616-365-2336
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ACCOUNTANT-SPECIAL PROJECTS
-----------------------------------------------------
Name | MRS. SUSAN ANN SZYMAS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 616-365-2395
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------