MEDICARE: LAKE COUNTY OFFICE OF EDUCATION

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	:	1609676543
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKE COUNTY OFFICE OF EDUCATION

Provider Business Mailing Address
First Line	:	1152 S MAIN ST
Second Line	:
City	:	LAKEPORT
State	:	CA
Zip	:	95453-5517
Country	:	US
Telephone Number	:	707-262-4100
Fax Number	:

Provider Business Practice Location Address
First Line	:	9430 LAKE ST
Second Line	:
City	:	LOWER LAKE
State	:	CA
Zip	:	95457-8600
Country	:	US
Telephone Number	:	707-994-6471
Fax Number	:

Authorized Official
Title or Position	:	ASSISTANT SUPERINTENDENT FISCAL SVC
Name	:	DENISE SHANNON
Credential	:
Telephone Number	:	707-262-4100

Provider Enumeration Date	:	03/18/2025
Last Update Date	:	03/18/2025

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Directions to “LAKE COUNTY OFFICE OF EDUCATION ” Practice Location

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