Provider Demographics
NPI:1225253859
Name:MAPLE DALE - INDIAN HILL SCHOOL DISTRICT
Entity type:Organization
Organization Name:MAPLE DALE - INDIAN HILL SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SPEC. ED PUPIL SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:DEB
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK-WESTFAHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-351-7170
Mailing Address - Street 1:2600 W MILL RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-3212
Mailing Address - Country:US
Mailing Address - Phone:414-351-7170
Mailing Address - Fax:414-434-0109
Practice Address - Street 1:2600 W MILL RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53209-3212
Practice Address - Country:US
Practice Address - Phone:414-351-7170
Practice Address - Fax:414-434-0109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44234800Medicaid