Provider Demographics
NPI:1417123878
Name:CLINTON COMMUNITY SCHOOL DISTRICT
Entity Type:Organization
Organization Name:CLINTON COMMUNITY SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIEFERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-676-5482
Mailing Address - Street 1:112 MILWAUKEE RD
Mailing Address - Street 2:PO BOX 566
Mailing Address - City:CLINTON
Mailing Address - State:WI
Mailing Address - Zip Code:53525-9468
Mailing Address - Country:US
Mailing Address - Phone:608-676-5482
Mailing Address - Fax:608-676-4444
Practice Address - Street 1:112 MILWAUKEE RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:WI
Practice Address - Zip Code:53525-9468
Practice Address - Country:US
Practice Address - Phone:608-676-5482
Practice Address - Fax:608-676-4444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI44205800251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44205800Medicaid