Provider Demographics
NPI:1508082975
Name:JOINT SCHOOL DISTRICT 171
Entity Type:Organization
Organization Name:JOINT SCHOOL DISTRICT 171
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL EDUCATION DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNDELL
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:208-476-4810
Mailing Address - Street 1:PO BOX 2259
Mailing Address - Street 2:
Mailing Address - City:OROFINO
Mailing Address - State:ID
Mailing Address - Zip Code:83544-2259
Mailing Address - Country:US
Mailing Address - Phone:208-476-4810
Mailing Address - Fax:208-476-3724
Practice Address - Street 1:1145 AHSAHKA RD
Practice Address - Street 2:
Practice Address - City:OROFINO
Practice Address - State:ID
Practice Address - Zip Code:83544-9058
Practice Address - Country:US
Practice Address - Phone:208-476-4810
Practice Address - Fax:208-476-3724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8052635Medicaid