Provider Demographics
NPI:1275712804
Name:WATERLOO SCHOOL DISTRICT
Entity Type:Organization
Organization Name:WATERLOO SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCHIESTL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-478-3633
Mailing Address - Street 1:813 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:WI
Mailing Address - Zip Code:53594-1171
Mailing Address - Country:US
Mailing Address - Phone:920-478-3633
Mailing Address - Fax:920-478-3821
Practice Address - Street 1:813 N MONROE ST
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:WI
Practice Address - Zip Code:53594-1171
Practice Address - Country:US
Practice Address - Phone:920-478-3633
Practice Address - Fax:920-478-3821
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
WI44203600Medicaid