Provider Demographics
NPI:1285668566
Name:CONSOLIDATED SCHOOL DISTICT #120
Entity Type:Organization
Organization Name:CONSOLIDATED SCHOOL DISTICT #120
Other - Org Name:MABTON SCHOOL DISTRICT
Other - Org Type:Other Name
Authorized Official - Title/Position:SPECIAL EDUCATION DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:M
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:509-894-4941
Mailing Address - Street 1:805 WASHINGTON STREET
Mailing Address - Street 2:PO BOX 40
Mailing Address - City:MABTON
Mailing Address - State:WA
Mailing Address - Zip Code:98935
Mailing Address - Country:US
Mailing Address - Phone:509-894-4941
Mailing Address - Fax:509-894-5110
Practice Address - Street 1:805 WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:MABTON
Practice Address - State:WA
Practice Address - Zip Code:98935
Practice Address - Country:US
Practice Address - Phone:509-894-4941
Practice Address - Fax:509-894-5110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7441389Medicaid