Provider Demographics
NPI:1922445550
Name:EDUCATIONAL SUPPORT SERVICES
Entity Type:Organization
Organization Name:EDUCATIONAL SUPPORT SERVICES
Other - Org Name:MEDICAL LAKE SCHOOL DISTRICT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:MARDEE
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-565-3145
Mailing Address - Street 1:317 N BROAD ST
Mailing Address - Street 2:BOX 128
Mailing Address - City:MEDICAL LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99022-8763
Mailing Address - Country:US
Mailing Address - Phone:509-565-3145
Mailing Address - Fax:509-565-3149
Practice Address - Street 1:317 N BROAD ST
Practice Address - Street 2:BOX 128
Practice Address - City:MEDICAL LAKE
Practice Address - State:WA
Practice Address - Zip Code:99022-8763
Practice Address - Country:US
Practice Address - Phone:509-565-3145
Practice Address - Fax:509-565-3149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)