Provider Demographics
NPI:1629358486
Name:GOWER SCHOOL DISTRICT 62
Entity Type:Organization
Organization Name:GOWER SCHOOL DISTRICT 62
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VESNA
Authorized Official - Middle Name:
Authorized Official - Last Name:NIKOLIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-986-5383
Mailing Address - Street 1:7700 CLARENDON HILLS RD
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-2426
Mailing Address - Country:US
Mailing Address - Phone:630-986-5383
Mailing Address - Fax:
Practice Address - Street 1:7700 CLARENDON HILLS RD
Practice Address - Street 2:
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-2426
Practice Address - Country:US
Practice Address - Phone:630-986-5383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid