Provider Demographics
NPI:1013046614
Name:SPEC EDUC DIST LAKE CO SEDOL
Entity type:Organization
Organization Name:SPEC EDUC DIST LAKE CO SEDOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:PUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-548-8470
Mailing Address - Street 1:18160 W GAGES LAKE RD
Mailing Address - Street 2:
Mailing Address - City:GAGES LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-1819
Mailing Address - Country:US
Mailing Address - Phone:847-548-8470
Mailing Address - Fax:847-548-8472
Practice Address - Street 1:18160 W GAGES LAKE RD
Practice Address - Street 2:
Practice Address - City:GAGES LAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-1819
Practice Address - Country:US
Practice Address - Phone:847-548-8470
Practice Address - Fax:847-548-8472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)