Provider Demographics
NPI:1093862393
Name:GRAND FORKS PUBLIC SCHOOLS DISTRICT 1
Entity Type:Organization
Organization Name:GRAND FORKS PUBLIC SCHOOLS DISTRICT 1
Other - Org Name:GRAND FORKS SPECIAL EDUCATION
Other - Org Type:Other Name
Authorized Official - Title/Position:SPECIAL EDUCATION DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELISA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIEDERICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-746-2230
Mailing Address - Street 1:PO BOX 6000
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58206-6000
Mailing Address - Country:US
Mailing Address - Phone:701-746-2230
Mailing Address - Fax:701-746-2475
Practice Address - Street 1:2400 47TH AVE S
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-3405
Practice Address - Country:US
Practice Address - Phone:701-746-2230
Practice Address - Fax:701-746-2475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Yes251300000XAgenciesLocal Education Agency (LEA)Group - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1455764Medicaid
ND19035Medicaid
ND19036Medicaid
ND19008Medicaid