Provider Demographics
NPI:1689738601
Name:CORVALLIS SCHOOL DISTRICT 509J
Entity Type:Organization
Organization Name:CORVALLIS SCHOOL DISTRICT 509J
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS SERVICES MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-757-5927
Mailing Address - Street 1:1555 SW 35TH ST
Mailing Address - Street 2:PO BOX 3509J
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-1130
Mailing Address - Country:US
Mailing Address - Phone:541-757-5811
Mailing Address - Fax:541-757-5703
Practice Address - Street 1:1555 SW 35TH ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-1130
Practice Address - Country:US
Practice Address - Phone:541-757-5811
Practice Address - Fax:541-757-5703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR020821Medicaid