Provider Demographics
NPI:1104077411
Name:RIVER RIDGE SCHOOL DISTRICT
Entity type:Organization
Organization Name:RIVER RIDGE SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SCHOOL PSYCHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:MEZERA
Authorized Official - Suffix:
Authorized Official - Credentials:MSE
Authorized Official - Phone:608-994-2715
Mailing Address - Street 1:11165 COUNTY HWY P
Mailing Address - Street 2:BOX 78
Mailing Address - City:PATCH GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53817-0078
Mailing Address - Country:US
Mailing Address - Phone:608-994-2715
Mailing Address - Fax:608-994-2891
Practice Address - Street 1:11165 COUNTY HWY P
Practice Address - Street 2:BOX 78
Practice Address - City:PATCH GROVE
Practice Address - State:WI
Practice Address - Zip Code:53817-0078
Practice Address - Country:US
Practice Address - Phone:608-994-2715
Practice Address - Fax:608-994-2891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4904251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)