Provider Demographics
NPI:1841221934
Name:ISSAQUAH SCHOOL DISTRICT
Entity Type:Organization
Organization Name:ISSAQUAH SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ED.D.
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:K
Authorized Official - Last Name:HOLM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-837-7085
Mailing Address - Street 1:565 NW HOLLY ST
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-2834
Mailing Address - Country:US
Mailing Address - Phone:425-837-7085
Mailing Address - Fax:425-837-7188
Practice Address - Street 1:565 NW HOLLY ST
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2834
Practice Address - Country:US
Practice Address - Phone:425-837-7085
Practice Address - Fax:425-837-7188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
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
WA7441793Medicaid