Provider Demographics
NPI:1710168281
Name:DESOTO AREA SCHOOL DISTRICT
Entity Type:Organization
Organization Name:DESOTO AREA SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL EDUCATION DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-648-0107
Mailing Address - Street 1:615 MAIN ST
Mailing Address - Street 2:ATTN: SPECIAL EDUCATION DEPARTMENT
Mailing Address - City:DE SOTO
Mailing Address - State:WI
Mailing Address - Zip Code:54624-8644
Mailing Address - Country:US
Mailing Address - Phone:608-648-0124
Mailing Address - Fax:608-648-3959
Practice Address - Street 1:615 MAIN ST
Practice Address - Street 2:ATTN: SPECIAL EDUCATION DEPARTMENT
Practice Address - City:DESOTO
Practice Address - State:WI
Practice Address - Zip Code:54624-8644
Practice Address - Country:US
Practice Address - Phone:608-648-0124
Practice Address - Fax:608-648-3959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44203100Medicaid