Provider Demographics
NPI:1235553348
Name:MARYSVILLE SCHOOL DISTRICT
Entity Type:Organization
Organization Name:MARYSVILLE SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SPECIAL ED SVCS
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:SUCHAN TOOTHAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MA ED AND ADMINISTRA
Authorized Official - Phone:360-653-0825
Mailing Address - Street 1:4220 80TH STREET NE
Mailing Address - Street 2:MARYSVILLE SCHOOL DISTRICT
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270
Mailing Address - Country:US
Mailing Address - Phone:360-653-7058
Mailing Address - Fax:360-657-6824
Practice Address - Street 1:4220 80TH STREET NE
Practice Address - Street 2:MARYSVILLE SCHOOL DISTRICT
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270
Practice Address - Country:US
Practice Address - Phone:360-653-7058
Practice Address - Fax:360-657-6824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA350661E235Z00000X
WALL60432328235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty