=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598858110
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOOD CANAL SCHOOL DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2006
-----------------------------------------------------
Last Update Date | 11/02/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 111 N. STATE ROUTE 106
-----------------------------------------------------
City | SHELTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98584
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-877-5463
-----------------------------------------------------
Fax | 360-877-9123
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 111 N. STATE ROUTE 106
-----------------------------------------------------
City | SHELTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98584
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-877-5463
-----------------------------------------------------
Fax | 360-877-9123
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF SPECIAL SERVICES
-----------------------------------------------------
Name | MR. SKYLAR A. CARROLL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 360-877-5463
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------