Provider Demographics
NPI:1265600233
Name:NORTHWEST SPECIAL EDUCATION COOPERATIVE
Entity type:Organization
Organization Name:NORTHWEST SPECIAL EDUCATION COOPERATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:DAHL
Authorized Official - Suffix:
Authorized Official - Credentials:BSW, MSW, MS ED
Authorized Official - Phone:815-599-1947
Mailing Address - Street 1:310 N. WEST STREET
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:IL
Mailing Address - Zip Code:61028
Mailing Address - Country:US
Mailing Address - Phone:815-599-1947
Mailing Address - Fax:815-858-2195
Practice Address - Street 1:2037 W GALENA AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032-3004
Practice Address - Country:US
Practice Address - Phone:815-232-0331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid