Provider Demographics
NPI:1770762379
Name:SCHOOL DISTRICT OF WAUPACA
Entity type:Organization
Organization Name:SCHOOL DISTRICT OF WAUPACA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF EXCEPTIONAL EDUCATION
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:D
Authorized Official - Last Name:BAILIE
Authorized Official - Suffix:
Authorized Official - Credentials:MSE
Authorized Official - Phone:715-258-4124
Mailing Address - Street 1:515 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:WAUPACA
Mailing Address - State:WI
Mailing Address - Zip Code:54981-1658
Mailing Address - Country:US
Mailing Address - Phone:715-258-4124
Mailing Address - Fax:715-258-4125
Practice Address - Street 1:515 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:WAUPACA
Practice Address - State:WI
Practice Address - Zip Code:54981-1658
Practice Address - Country:US
Practice Address - Phone:715-258-4124
Practice Address - Fax:715-258-4125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44215100Medicaid