=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508578956
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BOONE CENTRAL SCHOOLS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/16/2022
-----------------------------------------------------
Last Update Date | 12/16/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 605 S 6TH ST
-----------------------------------------------------
City | ALBION
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68620-1543
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-395-2134
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 605 S 6TH ST
-----------------------------------------------------
City | ALBION
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68620-1543
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-395-2134
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SPED DIRECTOR
-----------------------------------------------------
Name | MARK HUDSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 402-395-2134
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TS0200X
-----------------------------------------------------
Taxonomy Name | School Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------