Provider Demographics
NPI:1649374810
Name:SAN JUAN ISLAND SCHOOL DISTRICT
Entity type:Organization
Organization Name:SAN JUAN ISLAND SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF STUDENT SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:KAY
Authorized Official - Middle Name:
Authorized Official - Last Name:JAKUTIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-317-5973
Mailing Address - Street 1:285 BLAIR AVENUE
Mailing Address - Street 2:PO BOX 458
Mailing Address - City:FRIDAY HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98250
Mailing Address - Country:US
Mailing Address - Phone:360-378-5214
Mailing Address - Fax:360-378-9750
Practice Address - Street 1:285 BLAIR AVENUE
Practice Address - Street 2:
Practice Address - City:FRIDAY HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98250
Practice Address - Country:US
Practice Address - Phone:360-378-5214
Practice Address - Fax:360-378-9750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
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
WA7442452Medicaid