Provider Demographics
NPI:1275790719
Name:WITTENBERG-BIRNAMWOOD SCHOOL DISTRICT
Entity Type:Organization
Organization Name:WITTENBERG-BIRNAMWOOD SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PUPIL SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:JOZWIAK-BOLDIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-253-4513
Mailing Address - Street 1:400 W GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:WITTENBERG
Mailing Address - State:WI
Mailing Address - Zip Code:54499-9276
Mailing Address - Country:US
Mailing Address - Phone:715-253-4513
Mailing Address - Fax:715-253-3588
Practice Address - Street 1:400 W GRAND AVE
Practice Address - Street 2:
Practice Address - City:WITTENBERG
Practice Address - State:WI
Practice Address - Zip Code:54499-9276
Practice Address - Country:US
Practice Address - Phone:715-253-4513
Practice Address - Fax:715-253-3588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44210000Medicaid