Provider Demographics
NPI:1710042247
Name:MCGREGOR ISD 004
Entity Type:Organization
Organization Name:MCGREGOR ISD 004
Other - Org Name:NORTHERN LIGHTS SPECIAL EDUCATION COOPERATIVE
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE ASSISTANT RECEPTIONIST
Authorized Official - Prefix:
Authorized Official - First Name:GERI
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNJACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-879-1283
Mailing Address - Street 1:302 14TH ST
Mailing Address - Street 2:
Mailing Address - City:CLOQUET
Mailing Address - State:MN
Mailing Address - Zip Code:55720-2102
Mailing Address - Country:US
Mailing Address - Phone:218-879-1283
Mailing Address - Fax:218-879-1285
Practice Address - Street 1:302 14TH ST
Practice Address - Street 2:
Practice Address - City:CLOQUET
Practice Address - State:MN
Practice Address - Zip Code:55720-2102
Practice Address - Country:US
Practice Address - Phone:218-879-1283
Practice Address - Fax:218-879-1285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)