Provider Demographics
NPI:1053050104
Name:UPPER LAKE UNIFIED SCHOOL DISTRICT
Entity Type:Organization
Organization Name:UPPER LAKE UNIFIED SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PUPIL PERSONNEL SERVICE
Authorized Official - Prefix:MS
Authorized Official - First Name:TENDERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:PPS
Authorized Official - Phone:707-275-2338
Mailing Address - Street 1:675 CLOVER VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:UPPER LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:95485-9220
Mailing Address - Country:US
Mailing Address - Phone:707-275-2338
Mailing Address - Fax:
Practice Address - Street 1:675 CLOVER VALLEY RD
Practice Address - Street 2:
Practice Address - City:UPPER LAKE
Practice Address - State:CA
Practice Address - Zip Code:95485-9220
Practice Address - Country:US
Practice Address - Phone:707-275-2338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)