Provider Demographics
NPI:1831388370
Name:CEDARBURG SCHOOL DISTRICT
Entity type:Organization
Organization Name:CEDARBURG SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR PUPIL SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-376-6140
Mailing Address - Street 1:W68N611 EVERGREEN BLVD
Mailing Address - Street 2:
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-1847
Mailing Address - Country:US
Mailing Address - Phone:262-376-6140
Mailing Address - Fax:262-376-6150
Practice Address - Street 1:W68N611 EVERGREEN BLVD
Practice Address - Street 2:
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012-1847
Practice Address - Country:US
Practice Address - Phone:262-376-6140
Practice Address - Fax:262-376-6150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60217800251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY60217800OtherMIDICAID TPID