Provider Demographics
NPI:1245403583
Name:WAUSAUKEE SCHOOL DISTRICT
Entity Type:Organization
Organization Name:WAUSAUKEE SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-856-5151
Mailing Address - Street 1:N11941 US HIGHWAY 141
Mailing Address - Street 2:PO BOX 258
Mailing Address - City:WAUSAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:54177-9300
Mailing Address - Country:US
Mailing Address - Phone:715-856-5151
Mailing Address - Fax:
Practice Address - Street 1:N11941 US HIGHWAY 141
Practice Address - Street 2:
Practice Address - City:WAUSAUKEE
Practice Address - State:WI
Practice Address - Zip Code:54177-9300
Practice Address - Country:US
Practice Address - Phone:715-856-5151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44241300OtherMEDICAID BILLING PROVIDER