MEDICARE: CLINTONVILLE PUBLIC SCHOOL DISTRICT

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)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629242870
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINTONVILLE PUBLIC SCHOOL DISTRICT

Provider Business Mailing Address
First Line	:	25 8TH ST
Second Line	:
City	:	CLINTONVILLE
State	:	WI
Zip	:	54929-1607
Country	:	US
Telephone Number	:	715-823-7215
Fax Number	:	715-823-1477

Provider Business Practice Location Address
First Line	:	45 W GREEN TREE RD
Second Line	:
City	:	CLINTONVILLE
State	:	WI
Zip	:	54929-1055
Country	:	US
Telephone Number	:	715-823-7215
Fax Number	:	715-823-1315

Authorized Official
Title or Position	:	DIRECTOR OF PUPIL SERVICES
Name	:	KAYRENE SCHULTZ
Credential	:
Telephone Number	:	715-823-7215

Provider Enumeration Date	:	04/18/2008
Last Update Date	:	04/18/2008

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Directions to “CLINTONVILLE PUBLIC SCHOOL DISTRICT ” Practice Location

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