Provider Demographics
NPI:1124402219
Name:SHERBURNE & NORTHERN WRIGHT SPECIAL EDUCATION COOPERATIVE
Entity Type:Organization
Organization Name:SHERBURNE & NORTHERN WRIGHT SPECIAL EDUCATION COOPERATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SPECIAL EDUCATION
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:NISTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-272-2051
Mailing Address - Street 1:302 WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:MN
Mailing Address - Zip Code:55362
Mailing Address - Country:US
Mailing Address - Phone:763-272-2050
Mailing Address - Fax:763-272-2059
Practice Address - Street 1:302 WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MN
Practice Address - Zip Code:55362
Practice Address - Country:US
Practice Address - Phone:763-272-2050
Practice Address - Fax:763-272-2059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-17
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN251300000XMedicaid