MEDICARE: NORTHWEST AEA 12

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	:	1871657908
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST AEA 12

Provider Business Mailing Address
First Line	:	1520 MORNINGSIDE AVE
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51106-1716
Country	:	US
Telephone Number	:	712-274-6000
Fax Number	:	712-274-6115

Provider Business Practice Location Address
First Line	:	1520 MORNINGSIDE AVE
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51106-1716
Country	:	US
Telephone Number	:	712-274-6000
Fax Number	:	712-274-6115

Authorized Official
Title or Position	:	CO-DIRECTOR OF SPECIAL EDUCATION
Name	:	ROGER HESS
Credential	:
Telephone Number	:	712-274-6000

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	08/22/2020

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Directions to “NORTHWEST AEA 12 ” Practice Location

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