Provider Demographics
NPI:1407120215
Name:DOUGLAS EDUCATION SERVICE DISTRICT
Entity Type:Organization
Organization Name:DOUGLAS EDUCATION SERVICE DISTRICT
Other - Org Name:DOUGLAS ESD - KLAMATH CO EI/ECSE
Other - Org Type:Other Name
Authorized Official - Title/Position:EI/ECSE REGIONAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC
Authorized Official - Phone:541-440-4777
Mailing Address - Street 1:1871 NE STEPHENS ST
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-1433
Mailing Address - Country:US
Mailing Address - Phone:541-440-4777
Mailing Address - Fax:541-440-4771
Practice Address - Street 1:3125 CROSBY AVE
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-5733
Practice Address - Country:US
Practice Address - Phone:541-883-4748
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-27
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency