Provider Demographics
NPI:1376716092
Name:MONTICELLO PUBLIC SCHOOL
Entity Type:Organization
Organization Name:MONTICELLO PUBLIC SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL EDUCATION COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:VOIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MSI
Authorized Official - Phone:608-938-4194
Mailing Address - Street 1:334 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:WI
Mailing Address - Zip Code:53570-9593
Mailing Address - Country:US
Mailing Address - Phone:608-938-4194
Mailing Address - Fax:
Practice Address - Street 1:334 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:WI
Practice Address - Zip Code:53570-9593
Practice Address - Country:US
Practice Address - Phone:608-938-4194
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44219000Medicaid