Provider Demographics
NPI:1124038476
Name:INDEPENDENT SCHOOL DISTRICT 492
Entity Type:Organization
Organization Name:INDEPENDENT SCHOOL DISTRICT 492
Other - Org Name:ISD 492
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF SPECIAL SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCHALLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-433-0955
Mailing Address - Street 1:401 3RD AVE NW
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-2378
Mailing Address - Country:US
Mailing Address - Phone:507-433-0955
Mailing Address - Fax:507-433-0958
Practice Address - Street 1:401 3RD AVE NW
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912-2378
Practice Address - Country:US
Practice Address - Phone:507-433-0955
Practice Address - Fax:507-433-0958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN243642600Medicaid