=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518439454
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTHBROOK/GLENVIEW SCHOOL DISTRICT 30
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/17/2018
-----------------------------------------------------
Last Update Date | 12/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2374 SHERMER RD
-----------------------------------------------------
City | NORTHBROOK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60062-6729
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-498-4190
-----------------------------------------------------
Fax | 847-498-8981
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2374 SHERMER RD
-----------------------------------------------------
City | NORTHBROOK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60062-6729
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SECRETARY TO THE DIR OF SPECIAL ED
-----------------------------------------------------
Name | TIFFANI CUNEO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 847-400-8963
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------