Provider Demographics
NPI:1366476996
Name:NORTHSHORE SCHOOL DISTRICT
Entity Type:Organization
Organization Name:NORTHSHORE SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, SECONDARY SPEC. EDUC.
Authorized Official - Prefix:MR
Authorized Official - First Name:ED
Authorized Official - Middle Name:
Authorized Official - Last Name:KOEHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-489-6296
Mailing Address - Street 1:3330 MONTE VILLA PKWY
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-8972
Mailing Address - Country:US
Mailing Address - Phone:425-489-6388
Mailing Address - Fax:425-489-6499
Practice Address - Street 1:3330 MONTE VILLA PKWY
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-8972
Practice Address - Country:US
Practice Address - Phone:425-489-6388
Practice Address - Fax:425-489-6499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7440522Medicaid