Provider Demographics
NPI:1659590701
Name:MUKWONAGO SCHOOL DISTRICT
Entity Type:Organization
Organization Name:MUKWONAGO SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PUPIL SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:MAXINE
Authorized Official - Middle Name:
Authorized Official - Last Name:TOWLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-363-6305
Mailing Address - Street 1:423 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:MUKWONAGO
Mailing Address - State:WI
Mailing Address - Zip Code:53149-1203
Mailing Address - Country:US
Mailing Address - Phone:262-363-6305
Mailing Address - Fax:262-363-6272
Practice Address - Street 1:423 DIVISION ST
Practice Address - Street 2:
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149-1203
Practice Address - Country:US
Practice Address - Phone:262-363-6305
Practice Address - Fax:262-363-6272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44217600Medicaid