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General NPI Number Information
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NPI Number | 1669199915
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Entity Type | Organization
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Legal Business Name | OUTLOOK ACADEMY SDA
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Dates
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Enumeration Date | 10/26/2022
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Last Update Date | 10/26/2022
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Provider Practice Location Address
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Address Line | 2879 116TH AVE
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City | ALLEGAN
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State | MI
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Zip | 49010-9004
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Country | US
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Telephone | 269-512-7791
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Fax |
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Provider Business Mailing Address
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Address Line | 310 THOMAS ST
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City | ALLEGAN
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State | MI
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Zip | 49010-9158
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Country | US
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Telephone | 269-512-7791
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Fax |
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Authorized Official
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Title or Position | BUSINESS SERVICES COORDINATOR
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Name | AUBREY KLAMER
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Credential |
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Telephone | 269-512-7791
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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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