Provider Demographics
NPI:1629242870
Name:CLINTONVILLE PUBLIC SCHOOL DISTRICT
Entity Type:Organization
Organization Name:CLINTONVILLE PUBLIC SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PUPIL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:KAYRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-823-7215
Mailing Address - Street 1:25 8TH ST
Mailing Address - Street 2:
Mailing Address - City:CLINTONVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54929-1607
Mailing Address - Country:US
Mailing Address - Phone:715-823-7215
Mailing Address - Fax:715-823-1477
Practice Address - Street 1:45 W GREEN TREE RD
Practice Address - Street 2:
Practice Address - City:CLINTONVILLE
Practice Address - State:WI
Practice Address - Zip Code:54929-1055
Practice Address - Country:US
Practice Address - Phone:715-823-7215
Practice Address - Fax:715-823-1315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44202400OtherMEDICAID PROVIDER NUMBER