Provider Demographics
NPI:1043397961
Name:INDEPENDENT SCHOOL DISTRICT NO. 177
Entity Type:Organization
Organization Name:INDEPENDENT SCHOOL DISTRICT NO. 177
Other - Org Name:WINDOM PUBLIC SCHOOL
Other - Org Type:Other Name
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WORMSTADT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-831-6901
Mailing Address - Street 1:1400 17TH ST
Mailing Address - Street 2:PO BOX C-177
Mailing Address - City:WINDOM
Mailing Address - State:MN
Mailing Address - Zip Code:56101-1147
Mailing Address - Country:US
Mailing Address - Phone:507-831-6901
Mailing Address - Fax:507-831-6919
Practice Address - Street 1:1400 17TH ST
Practice Address - Street 2:
Practice Address - City:WINDOM
Practice Address - State:MN
Practice Address - Zip Code:56101-1147
Practice Address - Country:US
Practice Address - Phone:507-831-6901
Practice Address - Fax:507-831-6919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8771368251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)