Provider Demographics
NPI:1215116769
Name:KEWAUNEE SCHOOL DISTRICT
Entity type:Organization
Organization Name:KEWAUNEE SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:M
Authorized Official - Last Name:DAX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-388-3230
Mailing Address - Street 1:915 2ND ST
Mailing Address - Street 2:
Mailing Address - City:KEWAUNEE
Mailing Address - State:WI
Mailing Address - Zip Code:54216-1619
Mailing Address - Country:US
Mailing Address - Phone:920-388-3230
Mailing Address - Fax:920-388-5174
Practice Address - Street 1:915 2ND ST
Practice Address - Street 2:
Practice Address - City:KEWAUNEE
Practice Address - State:WI
Practice Address - Zip Code:54216-1619
Practice Address - Country:US
Practice Address - Phone:920-388-3230
Practice Address - Fax:920-388-5174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44211500Medicaid