Provider Demographics
NPI:1194846501
Name:WILLOW SPRINGS SCH DIST 108
Entity Type:Organization
Organization Name:WILLOW SPRINGS SCH DIST 108
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIEZENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-839-6828
Mailing Address - Street 1:8345 ARCHER AVE
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60480-1402
Mailing Address - Country:US
Mailing Address - Phone:708-839-6828
Mailing Address - Fax:708-839-8399
Practice Address - Street 1:8345 ARCHER AVE
Practice Address - Street 2:
Practice Address - City:WILLOW SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60480-1402
Practice Address - Country:US
Practice Address - Phone:708-839-6828
Practice Address - Fax:708-839-8399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health