Provider Demographics
NPI:1649289117
Name:SOUTH WHIDBEY SCHOOL DISTRICT
Entity type:Organization
Organization Name:SOUTH WHIDBEY SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF STUDENT SUPPORT
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-221-6100
Mailing Address - Street 1:721 CAMANO AVENUE
Mailing Address - Street 2:PO BOX 346
Mailing Address - City:LANGLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98260-0346
Mailing Address - Country:US
Mailing Address - Phone:360-221-6100
Mailing Address - Fax:360-221-3835
Practice Address - Street 1:721 CAMANO AVENUE
Practice Address - Street 2:
Practice Address - City:LANGLEY
Practice Address - State:WA
Practice Address - Zip Code:98260-0346
Practice Address - Country:US
Practice Address - Phone:360-221-6100
Practice Address - Fax:360-221-3835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7441991Medicaid