Provider Demographics
NPI:1285715128
Name:COUNTY OF CLARK SCHOOL DISTRICT 117
Entity type:Organization
Organization Name:COUNTY OF CLARK SCHOOL DISTRICT 117
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:INA
Authorized Official - Middle Name:
Authorized Official - Last Name:EVERS-MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-833-5400
Mailing Address - Street 1:1919 NE IONE ST
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-1148
Mailing Address - Country:US
Mailing Address - Phone:360-833-5400
Mailing Address - Fax:360-833-5402
Practice Address - Street 1:1919 NE IONE ST
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-1148
Practice Address - Country:US
Practice Address - Phone:360-833-5400
Practice Address - Fax:360-833-5402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7442494Medicaid