Provider Demographics
NPI:1063874600
Name:JANE GOODALL ENVIRONMENTAL SCIENCES ACADEMY
Entity type:Organization
Organization Name:JANE GOODALL ENVIRONMENTAL SCIENCES ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN DESIGNEE
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:S
Authorized Official - Last Name:WIGNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-852-0129
Mailing Address - Street 1:8008 83RD ST NW
Mailing Address - Street 2:
Mailing Address - City:MAPLE LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55358
Mailing Address - Country:US
Mailing Address - Phone:952-852-0129
Mailing Address - Fax:
Practice Address - Street 1:8008 83RD ST. NW
Practice Address - Street 2:
Practice Address - City:MAPLE LAKE
Practice Address - State:MN
Practice Address - Zip Code:55358
Practice Address - Country:US
Practice Address - Phone:952-852-0129
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)