Provider Demographics
NPI:1215105291
Name:STOCKTON CUSD 206
Entity type:Organization
Organization Name:STOCKTON CUSD 206
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:KATHIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-947-3321
Mailing Address - Street 1:500 N RUSH ST # M
Mailing Address - Street 2:SUITE A
Mailing Address - City:STOCKTON
Mailing Address - State:IL
Mailing Address - Zip Code:61085-1004
Mailing Address - Country:US
Mailing Address - Phone:815-947-3321
Mailing Address - Fax:
Practice Address - Street 1:500 N RUSH ST # M
Practice Address - Street 2:SUITE A
Practice Address - City:STOCKTON
Practice Address - State:IL
Practice Address - Zip Code:61085-1004
Practice Address - Country:US
Practice Address - Phone:815-947-3321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid