Provider Demographics
NPI:1255510855
Name:WEYAUWEGA-FREMONT SCHOOL DISTRICT
Entity type:Organization
Organization Name:WEYAUWEGA-FREMONT SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SBS CONTACT
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:F
Authorized Official - Last Name:PRILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-867-2148
Mailing Address - Street 1:410 E ANN ST
Mailing Address - Street 2:P.O. BOX 580
Mailing Address - City:WEYAUWEGA
Mailing Address - State:WI
Mailing Address - Zip Code:54983-8532
Mailing Address - Country:US
Mailing Address - Phone:920-867-2148
Mailing Address - Fax:920-867-2510
Practice Address - Street 1:410 E ANN ST
Practice Address - Street 2:
Practice Address - City:WEYAUWEGA
Practice Address - State:WI
Practice Address - Zip Code:54983-8532
Practice Address - Country:US
Practice Address - Phone:920-867-2148
Practice Address - Fax:920-867-2510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI44219400251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44219400Medicaid