Provider Demographics
NPI:1710166525
Name:JT SCHOOL DIST 1
Entity Type:Organization
Organization Name:JT SCHOOL DIST 1
Other - Org Name:WATERFORD GRADED SCHOOL
Other - Org Type:Other Name
Authorized Official - Title/Position:BOOKKEEPER/OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHUTTENHELM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-514-8200
Mailing Address - Street 1:819 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53185-4025
Mailing Address - Country:US
Mailing Address - Phone:262-514-8200
Mailing Address - Fax:262-514-8251
Practice Address - Street 1:819 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:WI
Practice Address - Zip Code:53185-4025
Practice Address - Country:US
Practice Address - Phone:262-514-8200
Practice Address - Fax:262-514-8251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44242900Medicaid