Provider Demographics
NPI:1104040716
Name:KINGSTON SCHOOL DIST 14
Entity Type:Organization
Organization Name:KINGSTON SCHOOL DIST 14
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SPECIAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-438-4982
Mailing Address - Street 1:10047 DIAMOND RD
Mailing Address - Street 2:
Mailing Address - City:CADET
Mailing Address - State:MO
Mailing Address - Zip Code:63630-9581
Mailing Address - Country:US
Mailing Address - Phone:573-438-4982
Mailing Address - Fax:573-438-5264
Practice Address - Street 1:10047 DIAMOND RD
Practice Address - Street 2:
Practice Address - City:CADET
Practice Address - State:MO
Practice Address - Zip Code:63630-9581
Practice Address - Country:US
Practice Address - Phone:573-438-4982
Practice Address - Fax:573-438-5264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251300000XAgenciesLocal Education Agency (LEA)
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO506101104Medicaid