Provider Demographics
NPI:1215963749
Name:WEST BRANCH AREA SCHOOL DISTRICT
Entity type:Organization
Organization Name:WEST BRANCH AREA SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:E
Authorized Official - Last Name:DUTROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-345-5615
Mailing Address - Street 1:516 ALLPORT CUTOFF
Mailing Address - Street 2:
Mailing Address - City:MORRISDALE
Mailing Address - State:PA
Mailing Address - Zip Code:16858-9727
Mailing Address - Country:US
Mailing Address - Phone:814-345-5615
Mailing Address - Fax:814-345-5220
Practice Address - Street 1:516 ALLPORT CUTOFF
Practice Address - Street 2:
Practice Address - City:MORRISDALE
Practice Address - State:PA
Practice Address - Zip Code:16858-9727
Practice Address - Country:US
Practice Address - Phone:814-345-5615
Practice Address - Fax:814-345-5220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0013975380001Medicaid