Provider Demographics
NPI:1316002835
Name:INDEPENDENT SCHOOL DISTRICT NO 712
Entity Type:Organization
Organization Name:INDEPENDENT SCHOOL DISTRICT NO 712
Other - Org Name:MT IRON BUHL SCHOOL DISTRICT 712 NORTHLAND SPECIAL ED COOP
Other - Org Type:Other Name
Authorized Official - Title/Position:SECRETARY OF SPECIAL EDUCATION TPB
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAUNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-741-5284
Mailing Address - Street 1:1201 13TH AVENUE S
Mailing Address - Street 2:PO BOX 1286
Mailing Address - City:VIRGINIA
Mailing Address - State:MN
Mailing Address - Zip Code:55792-1286
Mailing Address - Country:US
Mailing Address - Phone:218-741-5284
Mailing Address - Fax:218-741-5384
Practice Address - Street 1:5529 EMERALD AVENUEW
Practice Address - Street 2:
Practice Address - City:MT IRON
Practice Address - State:MN
Practice Address - Zip Code:55768-2068
Practice Address - Country:US
Practice Address - Phone:218-735-8271
Practice Address - Fax:218-735-8244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN626855200OtherMN ITS USER ID
MN626855200OtherMHCP