=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922287556
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STANLEY-BOYD SCHOOL DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/31/2007
-----------------------------------------------------
Last Update Date | 10/31/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 507 E 1ST AVE
-----------------------------------------------------
City | STANLEY
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54768-1279
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-644-5357
-----------------------------------------------------
Fax | 715-644-1279
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 507 E 1ST AVE
-----------------------------------------------------
City | STANLEY
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54768-1279
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-644-5357
-----------------------------------------------------
Fax | 715-644-1279
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | JIM JONES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 715-644-5357
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------