Provider Demographics
NPI:1982829776
Name:FOND DU LAC SCHOOL DISTRICT
Entity Type:Organization
Organization Name:FOND DU LAC SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PUPIL SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:VON TISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:902-906-6520
Mailing Address - Street 1:72 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-4956
Mailing Address - Country:US
Mailing Address - Phone:920-906-6520
Mailing Address - Fax:920-929-6858
Practice Address - Street 1:72 W 9TH ST
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-4956
Practice Address - Country:US
Practice Address - Phone:920-906-6520
Practice Address - Fax:920-929-6858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44201600Medicaid