Provider Demographics
NPI:1750615852
Name:CREST USD 479
Entity type:Organization
Organization Name:CREST USD 479
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEANNE
Authorized Official - Middle Name:J
Authorized Official - Last Name:TRABUC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-852-3540
Mailing Address - Street 1:603 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:COLONY
Mailing Address - State:KS
Mailing Address - Zip Code:66015-0305
Mailing Address - Country:US
Mailing Address - Phone:620-852-3540
Mailing Address - Fax:620-852-3542
Practice Address - Street 1:603 E BROAD ST
Practice Address - Street 2:
Practice Address - City:COLONY
Practice Address - State:KS
Practice Address - Zip Code:66015-0305
Practice Address - Country:US
Practice Address - Phone:620-852-3540
Practice Address - Fax:620-852-3542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)