=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679993570
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SCHOOL DISTRICT 3 REORGANIZED SHANNON COUNTY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2014
-----------------------------------------------------
Last Update Date | 06/15/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | HWY 19 NORTH
-----------------------------------------------------
City | WINONA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65588
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-325-8101
-----------------------------------------------------
Fax | 573-325-8447
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 248 HWY 19 NORTH
-----------------------------------------------------
City | WINONA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65588
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-325-8101
-----------------------------------------------------
Fax | 573-325-8447
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SPECIAL EDUCATION DIRECTOR
-----------------------------------------------------
Name | TRACY CRIDER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 573-325-8101
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------