Provider Demographics
NPI:1154598035
Name:CLAYTON PUBLIC SCHOOLS
Entity type:Organization
Organization Name:CLAYTON PUBLIC SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL EDUCATION SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-881-8704
Mailing Address - Street 1:300 W CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08312-1712
Mailing Address - Country:US
Mailing Address - Phone:856-881-8704
Mailing Address - Fax:856-863-8196
Practice Address - Street 1:300 W CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NJ
Practice Address - Zip Code:08312-1712
Practice Address - Country:US
Practice Address - Phone:856-881-8704
Practice Address - Fax:856-863-8196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-10
Last Update Date:2008-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6505104Medicaid