Provider Demographics
NPI:1750501524
Name:CLEAR LAKE COMMUNITY SCHOOL DISTRICT
Entity Type:Organization
Organization Name:CLEAR LAKE COMMUNITY SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR SCHOOL HEALTH SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LIVINGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-357-6114
Mailing Address - Street 1:306 1ST AVE N
Mailing Address - Street 2:
Mailing Address - City:CLEAR LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:50428-1807
Mailing Address - Country:US
Mailing Address - Phone:641-357-6114
Mailing Address - Fax:641-357-8353
Practice Address - Street 1:306 1ST AVE N
Practice Address - Street 2:
Practice Address - City:CLEAR LAKE
Practice Address - State:IA
Practice Address - Zip Code:50428-1807
Practice Address - Country:US
Practice Address - Phone:641-357-6114
Practice Address - Fax:641-357-8353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0283663Medicaid