Provider Demographics
NPI: | 1518019371 |
---|---|
Name: | ESPANOLA PUBLIC SCHOOLS |
Entity Type: | Organization |
Organization Name: | ESPANOLA PUBLIC SCHOOLS |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | SUPERINTENDENT |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | DAVID |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | COCKERHAM |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 505-753-2254 |
Mailing Address - Street 1: | PO BOX 1005 |
Mailing Address - Street 2: | |
Mailing Address - City: | CHIMAYO |
Mailing Address - State: | NM |
Mailing Address - Zip Code: | 87522-1005 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 505-660-7822 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 714 CALLE DON DIEGO |
Practice Address - Street 2: | |
Practice Address - City: | ESPANOLA |
Practice Address - State: | NM |
Practice Address - Zip Code: | 87532-3414 |
Practice Address - Country: | US |
Practice Address - Phone: | 505-753-2254 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-01-18 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NM | 2692 | 235Z00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Single Specialty |