Provider Demographics
NPI:1215026059
Name:EAST VALLEY SCHOOL DISTRICT - YAKIMA
Entity Type:Organization
Organization Name:EAST VALLEY SCHOOL DISTRICT - YAKIMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL PROGRAMS/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARQUETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-573-7330
Mailing Address - Street 1:2002 BEAUDRY RD
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901-8012
Mailing Address - Country:US
Mailing Address - Phone:509-573-7324
Mailing Address - Fax:509-573-7340
Practice Address - Street 1:2002 BEAUDRY RD
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-8012
Practice Address - Country:US
Practice Address - Phone:509-573-7324
Practice Address - Fax:509-573-7340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7441512Medicaid