Provider Demographics
NPI:1487833190
Name:SCHOOL DISTRICT OF MARSHFIELD
Entity type:Organization
Organization Name:SCHOOL DISTRICT OF MARSHFIELD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF STUDENT SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:ED D
Authorized Official - Phone:715-387-1101
Mailing Address - Street 1:1010 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-4538
Mailing Address - Country:US
Mailing Address - Phone:715-387-1101
Mailing Address - Fax:715-387-0133
Practice Address - Street 1:1010 E 4TH ST
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449-4538
Practice Address - Country:US
Practice Address - Phone:715-387-1101
Practice Address - Fax:715-387-0133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44209800Medicaid