Provider Demographics
NPI:1467629907
Name:J T SCHOOL DISTRICT 2
Entity Type:Organization
Organization Name:J T SCHOOL DISTRICT 2
Other - Org Name:VILLAGE OF WHITE LAKE & SCHOOL DISTRICT OF WHITE LAKE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR OF SPECIAL EDUCATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:WALL
Authorized Official - Suffix:
Authorized Official - Credentials:MSE
Authorized Official - Phone:715-882-2361
Mailing Address - Street 1:PO BOX 67
Mailing Address - Street 2:405 BISSELL STREET
Mailing Address - City:WHITE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54491-0067
Mailing Address - Country:US
Mailing Address - Phone:715-882-2361
Mailing Address - Fax:715-882-2914
Practice Address - Street 1:405 BISSELL STREET
Practice Address - Street 2:
Practice Address - City:WHITE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54491-0067
Practice Address - Country:US
Practice Address - Phone:715-882-2361
Practice Address - Fax:715-882-2914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI079225103T00000X
WI065019225X00000X
WI605019261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty