Provider Demographics
NPI:1225217789
Name:WALWORTH ELEMENTARY SCHOOL
Entity Type:Organization
Organization Name:WALWORTH ELEMENTARY SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:KNORR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-275-6896
Mailing Address - Street 1:121 BELOIT ST
Mailing Address - Street 2:
Mailing Address - City:WALWORTH
Mailing Address - State:WI
Mailing Address - Zip Code:53184-9638
Mailing Address - Country:US
Mailing Address - Phone:262-275-6896
Mailing Address - Fax:262-275-2272
Practice Address - Street 1:121 BELOIT ST
Practice Address - Street 2:
Practice Address - City:WALWORTH
Practice Address - State:WI
Practice Address - Zip Code:53184-9638
Practice Address - Country:US
Practice Address - Phone:262-275-6896
Practice Address - Fax:262-275-2272
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
WI44220700Medicaid