Provider Demographics
NPI:1033279542
Name:IND SCHOOL DISTRICT 191
Entity Type:Organization
Organization Name:IND SCHOOL DISTRICT 191
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ISS
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CORBEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-707-6261
Mailing Address - Street 1:100 RIVER RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-1613
Mailing Address - Country:US
Mailing Address - Phone:952-707-6260
Mailing Address - Fax:952-707-6262
Practice Address - Street 1:100 RIVER RIDGE CT
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-1613
Practice Address - Country:US
Practice Address - Phone:952-707-6260
Practice Address - Fax:952-707-6262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN343608000Medicaid