Provider Demographics
NPI:1689853384
Name:SCHOOL DISTRICT OF CHILTON
Entity Type:Organization
Organization Name:SCHOOL DISTRICT OF CHILTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAIRE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:920-849-8109
Mailing Address - Street 1:530 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHILTON
Mailing Address - State:WI
Mailing Address - Zip Code:53014-1369
Mailing Address - Country:US
Mailing Address - Phone:920-849-8109
Mailing Address - Fax:920-849-4539
Practice Address - Street 1:530 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CHILTON
Practice Address - State:WI
Practice Address - Zip Code:53014-1369
Practice Address - Country:US
Practice Address - Phone:920-849-8109
Practice Address - Fax:920-849-4539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44202300Medicaid