Provider Demographics
NPI:1790900504
Name:KIMBERLY AREA SCHOOL DISTRICT
Entity Type:Organization
Organization Name:KIMBERLY AREA SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PUPIL SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-788-7900
Mailing Address - Street 1:217 E KIMBERLY AVE
Mailing Address - Street 2:
Mailing Address - City:KIMBERLY
Mailing Address - State:WI
Mailing Address - Zip Code:54136-1404
Mailing Address - Country:US
Mailing Address - Phone:920-788-7900
Mailing Address - Fax:920-687-3060
Practice Address - Street 1:217 E KIMBERLY AVE
Practice Address - Street 2:
Practice Address - City:KIMBERLY
Practice Address - State:WI
Practice Address - Zip Code:54136-1404
Practice Address - Country:US
Practice Address - Phone:920-788-7900
Practice Address - Fax:920-687-3060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44216300Medicaid