Provider Demographics
NPI:1114196193
Name:LASALLE PUBLIC ELEM 122
Entity Type:Organization
Organization Name:LASALLE PUBLIC ELEM 122
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARTY
Authorized Official - Middle Name:
Authorized Official - Last Name:RICCONI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-433-6433
Mailing Address - Street 1:1165 SAINT VINCENTS AVE
Mailing Address - Street 2:
Mailing Address - City:LA SALLE
Mailing Address - State:IL
Mailing Address - Zip Code:61301-1628
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1165 SAINT VINCENTS AVE
Practice Address - Street 2:
Practice Address - City:LA SALLE
Practice Address - State:IL
Practice Address - Zip Code:61301-1628
Practice Address - Country:US
Practice Address - Phone:815-433-6433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)