Provider Demographics
NPI:1417047820
Name:CLEARBROOK-GONVICK ISD #2311
Entity Type:Organization
Organization Name:CLEARBROOK-GONVICK ISD #2311
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEHSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-776-3112
Mailing Address - Street 1:16770 CLEARWATER LAKE RD
Mailing Address - Street 2:
Mailing Address - City:CLEARBROOK
Mailing Address - State:MN
Mailing Address - Zip Code:56634-4223
Mailing Address - Country:US
Mailing Address - Phone:208-776-3112
Mailing Address - Fax:218-776-3117
Practice Address - Street 1:16770 CLEARWATER LAKE RD
Practice Address - Street 2:
Practice Address - City:CLEARBROOK
Practice Address - State:MN
Practice Address - Zip Code:56634-4223
Practice Address - Country:US
Practice Address - Phone:208-776-3112
Practice Address - Fax:218-776-3117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)