Provider Demographics
NPI:1235318007
Name:SCHOOL DISTRICT OF REEDSBURG
Entity Type:Organization
Organization Name:SCHOOL DISTRICT OF REEDSBURG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PUPIL SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:P
Authorized Official - Last Name:PERRODIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-524-2174
Mailing Address - Street 1:501 K ST
Mailing Address - Street 2:
Mailing Address - City:REEDSBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53959-1825
Mailing Address - Country:US
Mailing Address - Phone:608-524-2174
Mailing Address - Fax:608-524-6818
Practice Address - Street 1:501 K ST
Practice Address - Street 2:
Practice Address - City:REEDSBURG
Practice Address - State:WI
Practice Address - Zip Code:53959-1825
Practice Address - Country:US
Practice Address - Phone:608-524-2174
Practice Address - Fax:608-524-6818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44212300Medicaid