=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871710426
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FREEDOM SCHOOL DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | N4021 COUNTY ROAD E
-----------------------------------------------------
City | FREEDOM
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-788-7944
-----------------------------------------------------
Fax | 920-788-7949
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | N4021 CTY RD E, PO BOX 1008
-----------------------------------------------------
City | FREEDOM
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54131-1008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-788-7944
-----------------------------------------------------
Fax | 920-788-7949
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BUSINESS MANAGER
-----------------------------------------------------
Name | MS. MARGARET GAGNON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 920-788-7944
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------