Provider Demographics
NPI:1508908419
Name:SPECIAL SCHOOL DISTRICT OF PEMISCOT
Entity Type:Organization
Organization Name:SPECIAL SCHOOL DISTRICT OF PEMISCOT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL SERVICES DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHERA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-359-0021
Mailing Address - Street 1:1317 STATE HIGHWAY 84
Mailing Address - Street 2:
Mailing Address - City:HAYTI
Mailing Address - State:MO
Mailing Address - Zip Code:63851-1666
Mailing Address - Country:US
Mailing Address - Phone:573-359-0011
Mailing Address - Fax:573-359-6525
Practice Address - Street 1:1317 STATE HIGHWAY 84
Practice Address - Street 2:
Practice Address - City:HAYTI
Practice Address - State:MO
Practice Address - Zip Code:63851-1666
Practice Address - Country:US
Practice Address - Phone:573-359-0011
Practice Address - Fax:573-359-6525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251300000XAgenciesLocal Education Agency (LEA)
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO506257005Medicaid