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General NPI Number Information
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NPI Number | 1730417049
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Entity Type | Organization
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Legal Business Name | WINGS ACADEMY
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Dates
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Enumeration Date | 11/24/2009
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Last Update Date | 11/24/2009
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Provider Practice Location Address
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Address Line | 1501 S LAYTON BLVD
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City | MILWAUKEE
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State | WI
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Zip | 53215-1924
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Country | US
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Telephone | 414-431-1356
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Fax | 414-431-1358
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Provider Business Mailing Address
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Address Line | 1501 S LAYTON BLVD
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City | MILWAUKEE
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State | WI
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Zip | 53215-1924
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Country | US
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Telephone | 414-431-1356
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Fax | 414-431-1358
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Authorized Official
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Title or Position | SPECIAL EDUCATION COORDINATOR
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Name | MRS. SARA VAN DEURZEN
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Credential |
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Telephone | 414-755-3248
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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 | 046013
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License Number State | WI
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