MEDICARE: MARQUARDT SCHOOL DISTRICT 15

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1043488638
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARQUARDT SCHOOL DISTRICT 15

Provider Business Mailing Address
First Line	:	2174 GLANDSTONE COURT
Second Line	:	SUITE C
City	:	GLENDALE HTS
State	:	IL
Zip	:	60139-2261
Country	:	US
Telephone Number	:	630-942-5600
Fax Number	:

Provider Business Practice Location Address
First Line	:	2174 GLANDSTONE COURT
Second Line	:	SUITE C
City	:	GLENDALE HTS
State	:	IL
Zip	:	60139-2261
Country	:	US
Telephone Number	:	630-942-5600
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	GEORGIA PECENIAK
Credential	:
Telephone Number	:	630-942-5600

Provider Enumeration Date	:	02/15/2008
Last Update Date	:	02/15/2008

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Directions to “MARQUARDT SCHOOL DISTRICT 15 ” Practice Location

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