Provider Demographics
NPI:1043499718
Name:LAKE MILLS AREA SCHOOL DISTRICT
Entity Type:Organization
Organization Name:LAKE MILLS AREA SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PUPIL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:DOHRN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:920-648-2474
Mailing Address - Street 1:120 E LAKE PARK PL
Mailing Address - Street 2:
Mailing Address - City:LAKE MILLS
Mailing Address - State:WI
Mailing Address - Zip Code:53551-1531
Mailing Address - Country:US
Mailing Address - Phone:920-648-2474
Mailing Address - Fax:
Practice Address - Street 1:120 E LAKE PARK PL
Practice Address - Street 2:
Practice Address - City:LAKE MILLS
Practice Address - State:WI
Practice Address - Zip Code:53551-1531
Practice Address - Country:US
Practice Address - Phone:920-648-2474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44212800Medicaid