Provider Demographics
NPI:1407047251
Name:SCHOOL DISTRICT OF MAYVILLE
Entity Type:Organization
Organization Name:SCHOOL DISTRICT OF MAYVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL EDUCATION SECRETARY
Authorized Official - Prefix:MS
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HENKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-387-7970
Mailing Address - Street 1:445 N HENNINGER ST
Mailing Address - Street 2:
Mailing Address - City:MAYVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53050-2816
Mailing Address - Country:US
Mailing Address - Phone:920-387-7970
Mailing Address - Fax:920-387-7974
Practice Address - Street 1:445 N HENNINGER ST
Practice Address - Street 2:
Practice Address - City:MAYVILLE
Practice Address - State:WI
Practice Address - Zip Code:53050-2816
Practice Address - Country:US
Practice Address - Phone:920-387-7970
Practice Address - Fax:920-387-7974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44226400Medicaid