Provider Demographics
NPI:1134308760
Name:SCHOOL DISTRICT OF WABENO AREA
Entity Type:Organization
Organization Name:SCHOOL DISTRICT OF WABENO AREA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ODEKIRK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-473-2592
Mailing Address - Street 1:PO BOX 460
Mailing Address - Street 2:
Mailing Address - City:WABENO
Mailing Address - State:WI
Mailing Address - Zip Code:54566-0460
Mailing Address - Country:US
Mailing Address - Phone:715-473-2592
Mailing Address - Fax:715-473-5201
Practice Address - Street 1:4346 MILL LN
Practice Address - Street 2:
Practice Address - City:WABENO
Practice Address - State:WI
Practice Address - Zip Code:54566-9264
Practice Address - Country:US
Practice Address - Phone:715-473-2592
Practice Address - Fax:715-473-5201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44241100Medicaid