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General NPI Number Information
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NPI Number | 1578633269
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Entity Type | Organization
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Legal Business Name | ST. JOSEPH COUNTY ISD
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 62445 SHIMMEL RD
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City | CENTREVILLE
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State | MI
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Zip | 49032-9527
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Country | US
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Telephone | 269-467-5400
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Fax | 269-467-4309
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Provider Business Mailing Address
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Address Line | 62445 SHIMMEL RD
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City | CENTREVILLE
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State | MI
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Zip | 49032-9527
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Country | US
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Telephone | 269-467-5400
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Fax | 269-467-4309
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Authorized Official
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Title or Position | FINANCIAL ASSISTANT
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Name | COLLEEN CONKLE
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Credential |
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Telephone | 269-467-5418
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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 |
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License Number State |
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