Provider Demographics
NPI:1821153537
Name:INDEPENDENT SCHOOL DISTRICT 361
Entity Type:Organization
Organization Name:INDEPENDENT SCHOOL DISTRICT 361
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:FREDERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-283-2571
Mailing Address - Street 1:1515 11TH ST
Mailing Address - Street 2:
Mailing Address - City:INTERNATIONAL FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56649-2501
Mailing Address - Country:US
Mailing Address - Phone:218-283-2571
Mailing Address - Fax:218-283-2384
Practice Address - Street 1:1515 11TH ST
Practice Address - Street 2:
Practice Address - City:INTERNATIONAL FALLS
Practice Address - State:MN
Practice Address - Zip Code:56649-2501
Practice Address - Country:US
Practice Address - Phone:218-283-2571
Practice Address - Fax:218-283-2384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN934687200Medicare ID - Type Unspecified