Provider Demographics
NPI:1225103096
Name:WASHTENAW INTERMEDIATE SCHOOL DISTRICT
Entity Type:Organization
Organization Name:WASHTENAW INTERMEDIATE SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, STUDENT SVCS.
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-994-8100
Mailing Address - Street 1:1819 S WAGNER RD
Mailing Address - Street 2:P.O. BOX 1406
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-9715
Mailing Address - Country:US
Mailing Address - Phone:734-994-8100
Mailing Address - Fax:734-994-2203
Practice Address - Street 1:1819 S WAGNER RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-9715
Practice Address - Country:US
Practice Address - Phone:734-994-8100
Practice Address - Fax:734-994-2203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI773020295Medicaid