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General NPI Number Information
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NPI Number | 1831061118
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Entity Type | Organization
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Legal Business Name | DOUGLAS EDUCATION SERVICE DISTRICT
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Dates
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Enumeration Date | 09/18/2025
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Last Update Date | 09/18/2025
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Provider Practice Location Address
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Address Line | 1409 NE DIAMOND LAKE BLVD STE 110
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City | ROSEBURG
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State | OR
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Zip | 97470-3356
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Country | US
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Telephone | 541-440-4753
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Fax |
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Provider Business Mailing Address
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Address Line | 1409 NE DIAMOND LAKE BLVD STE 110
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City | ROSEBURG
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State | OR
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Zip | 97470-3356
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Country | US
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Telephone | 541-440-4753
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Fax | 541-440-4771
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Authorized Official
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Title or Position | SUPERINTENDENT
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Name | ANALICIA NICHOLSON
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Credential |
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Telephone | 541-440-4753
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WS0200X
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Taxonomy Name | School Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #3
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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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