Provider Demographics
NPI:1639634314
Name:CLACKAMAS COUNTY SCHOOL DISTRICT 86
Entity Type:Organization
Organization Name:CLACKAMAS COUNTY SCHOOL DISTRICT 86
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-266-0019
Mailing Address - Street 1:1130 S IVY STREET
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013
Mailing Address - Country:US
Mailing Address - Phone:503-266-0054
Mailing Address - Fax:503-266-0023
Practice Address - Street 1:1130 S IVY STREET
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013
Practice Address - Country:US
Practice Address - Phone:503-266-0054
Practice Address - Fax:503-266-0023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)