Provider Demographics
NPI:1801011317
Name:SHOREWOOD SCHOOL DISTRICT
Entity Type:Organization
Organization Name:SHOREWOOD SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF INSTRUCTIONAL SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-963-6906
Mailing Address - Street 1:1701 E CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:53211-1911
Mailing Address - Country:US
Mailing Address - Phone:414-963-6906
Mailing Address - Fax:414-963-6996
Practice Address - Street 1:1701 E CAPITOL DR
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:WI
Practice Address - Zip Code:53211-1911
Practice Address - Country:US
Practice Address - Phone:414-963-6906
Practice Address - Fax:414-963-6996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
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
WI44234700Medicaid