Provider Demographics
NPI:1902041585
Name:SYCAMORE CUSD #427
Entity Type:Organization
Organization Name:SYCAMORE CUSD #427
Other - Org Name:NORTHWESTERN ILLINOIS ASSOCIATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM REGIONAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KILPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-895-9227
Mailing Address - Street 1:245 W EXCHANGE ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-1495
Mailing Address - Country:US
Mailing Address - Phone:815-895-9227
Mailing Address - Fax:815-895-2971
Practice Address - Street 1:245 W EXCHANGE ST
Practice Address - Street 2:SUITE 4
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-1495
Practice Address - Country:US
Practice Address - Phone:815-895-9227
Practice Address - Fax:815-895-2971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-10
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL363072256001Medicaid