Provider Demographics
NPI:1104092410
Name:SCHOOL DISTRICT OF KOHLER
Entity type:Organization
Organization Name:SCHOOL DISTRICT OF KOHLER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:P
Authorized Official - Last Name:DICKERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-459-2920
Mailing Address - Street 1:333 UPPER RD
Mailing Address - Street 2:
Mailing Address - City:KOHLER
Mailing Address - State:WI
Mailing Address - Zip Code:53044-1545
Mailing Address - Country:US
Mailing Address - Phone:920-459-2920
Mailing Address - Fax:
Practice Address - Street 1:333 UPPER RD
Practice Address - Street 2:
Practice Address - City:KOHLER
Practice Address - State:WI
Practice Address - Zip Code:53044-1545
Practice Address - Country:US
Practice Address - Phone:920-459-2920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI44218000251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44218000Medicaid