Provider Demographics
NPI:1891863304
Name:WATERVILLE SCHOOL DISTRICT
Entity Type:Organization
Organization Name:WATERVILLE SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR-SPEC. EDUC. COOPERATIVE
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUTCHISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-750-7507
Mailing Address - Street 1:200 E BIRCH ST
Mailing Address - Street 2:PO BOX 490
Mailing Address - City:WATERVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98858
Mailing Address - Country:US
Mailing Address - Phone:509-745-8585
Mailing Address - Fax:509-745-9073
Practice Address - Street 1:200 E BIRCH ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:WA
Practice Address - Zip Code:98858
Practice Address - Country:US
Practice Address - Phone:509-745-8585
Practice Address - Fax:509-745-9073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
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
WA7442577Medicaid