Provider Demographics
NPI:1386996957
Name:MEDICAL LAKE SCHOOL DISTRICT
Entity type:Organization
Organization Name:MEDICAL LAKE SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SP. ED. DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL MUELLER
Authorized Official - Middle Name:
Authorized Official - Last Name:MUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-565-3125
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:MEDICAL LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99022-0128
Mailing Address - Country:US
Mailing Address - Phone:509-565-3100
Mailing Address - Fax:
Practice Address - Street 1:116 W. 3RD STREET
Practice Address - Street 2:
Practice Address - City:MEDICAL LAKE
Practice Address - State:WA
Practice Address - Zip Code:99022-0128
Practice Address - Country:US
Practice Address - Phone:509-565-3100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA220726D251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)