Provider Demographics
NPI:1285663997
Name:WALLOWA COUNTY ESD
Entity Type:Organization
Organization Name:WALLOWA COUNTY ESD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-426-4997
Mailing Address - Street 1:107 SW 1ST ST STE 105
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:OR
Mailing Address - Zip Code:97828-1285
Mailing Address - Country:US
Mailing Address - Phone:541-426-4997
Mailing Address - Fax:514-426-3732
Practice Address - Street 1:107 SW 1ST ST STE 105
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:OR
Practice Address - Zip Code:97828-1285
Practice Address - Country:US
Practice Address - Phone:541-426-4997
Practice Address - Fax:514-426-3732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR127881Medicaid