Provider Demographics
NPI:1760419030
Name:DIERINGER SCHOOL DISTRICT
Entity Type:Organization
Organization Name:DIERINGER SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF STUDENT SUPPORT SERVICE
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:STREECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-862-2537
Mailing Address - Street 1:1320 178TH AVE E
Mailing Address - Street 2:
Mailing Address - City:LAKE TAPPS
Mailing Address - State:WA
Mailing Address - Zip Code:98391-6411
Mailing Address - Country:US
Mailing Address - Phone:253-862-2537
Mailing Address - Fax:253-862-8472
Practice Address - Street 1:1320 178TH AVE E
Practice Address - Street 2:
Practice Address - City:LAKE TAPPS
Practice Address - State:WA
Practice Address - Zip Code:98391-6411
Practice Address - Country:US
Practice Address - Phone:253-862-2537
Practice Address - Fax:253-862-8472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7442627Medicaid