Provider Demographics
NPI:1104005081
Name:KICKAPOO AREA SCHOOL DISTRICT
Entity Type:Organization
Organization Name:KICKAPOO AREA SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMONSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-627-0101
Mailing Address - Street 1:S6520 STATE HIGHWAY 131
Mailing Address - Street 2:
Mailing Address - City:VIOLA
Mailing Address - State:WI
Mailing Address - Zip Code:54664-8528
Mailing Address - Country:US
Mailing Address - Phone:608-627-0104
Mailing Address - Fax:608-627-0118
Practice Address - Street 1:S6520 STATE HIGHWAY 131
Practice Address - Street 2:
Practice Address - City:VIOLA
Practice Address - State:WI
Practice Address - Zip Code:54664-8528
Practice Address - Country:US
Practice Address - Phone:608-627-0104
Practice Address - Fax:608-627-0118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44223800Medicaid