Provider Demographics
NPI:1649317066
Name:MOUNT PROSPECT SCHOOL DISTRICT 57
Entity type:Organization
Organization Name:MOUNT PROSPECT SCHOOL DISTRICT 57
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:GAWRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-385-3734
Mailing Address - Street 1:701 W GREGORY ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-2220
Mailing Address - Country:US
Mailing Address - Phone:847-385-3734
Mailing Address - Fax:
Practice Address - Street 1:701 W GREGORY ST
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-2220
Practice Address - Country:US
Practice Address - Phone:847-385-3734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid