Provider Demographics
NPI:1124208061
Name:SCHOOL DISTRICT OF POYNETTE
Entity Type:Organization
Organization Name:SCHOOL DISTRICT OF POYNETTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF STUDENT SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHITTICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-635-4347
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:POYNETTE
Mailing Address - State:WI
Mailing Address - Zip Code:53955-0010
Mailing Address - Country:US
Mailing Address - Phone:608-635-4347
Mailing Address - Fax:608-635-9200
Practice Address - Street 1:108 N CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:POYNETTE
Practice Address - State:WI
Practice Address - Zip Code:53955-8913
Practice Address - Country:US
Practice Address - Phone:608-635-4347
Practice Address - Fax:608-635-9200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44222400Medicaid