Provider Demographics
NPI:1942930458
Name:DEWITT LIVINGSTON LOGAN MCLEAN REGIONAL OFFICE OF EDUCATION #17
Entity Type:Organization
Organization Name:DEWITT LIVINGSTON LOGAN MCLEAN REGIONAL OFFICE OF EDUCATION #17
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:JONTRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-888-5120
Mailing Address - Street 1:201 E GROVE ST STE 300
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-7628
Mailing Address - Country:US
Mailing Address - Phone:309-888-5120
Mailing Address - Fax:
Practice Address - Street 1:408 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-3808
Practice Address - Country:US
Practice Address - Phone:309-828-5807
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)