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General NPI Number Information
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NPI Number | 1386996957
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Entity Type | Organization
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Legal Business Name | MEDICAL LAKE SCHOOL DISTRICT
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Dates
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Enumeration Date | 10/08/2012
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Last Update Date | 10/08/2012
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Provider Practice Location Address
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Address Line | 116 W. 3RD STREET
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City | MEDICAL LAKE
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State | WA
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Zip | 99022-0128
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Country | US
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Telephone | 509-565-3100
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 128
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City | MEDICAL LAKE
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State | WA
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Zip | 99022-0128
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Country | US
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Telephone | 509-565-3100
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Fax |
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Authorized Official
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Title or Position | SP. ED. DIRECTOR
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Name | MR. DANIEL MUELLER MUELLER
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Credential |
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Telephone | 509-565-3125
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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 | 220726D
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License Number State | WA
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