Provider Demographics
NPI:1568493781
Name:FERNDALE SCHOOL DISTRICT
Entity Type:Organization
Organization Name:FERNDALE SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SPECIAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:BERRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-383-9221
Mailing Address - Street 1:6041 VISTA DR
Mailing Address - Street 2:PO BOX 698
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248
Mailing Address - Country:US
Mailing Address - Phone:360-383-9221
Mailing Address - Fax:360-353-9230
Practice Address - Street 1:6041 VISTA DR
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248
Practice Address - Country:US
Practice Address - Phone:360-383-9221
Practice Address - Fax:360-353-9230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7442981Medicaid