Provider Demographics
NPI:1558176388
Name:CLACKAMAS EDUCATION SERVICE DISTRICT
Entity type:Organization
Organization Name:CLACKAMAS EDUCATION SERVICE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAID SUPPORT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-675-4141
Mailing Address - Street 1:13455 SE 97TH AVE
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-8662
Mailing Address - Country:US
Mailing Address - Phone:503-675-4141
Mailing Address - Fax:503-675-4200
Practice Address - Street 1:13455 SE 97TH AVE
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-8662
Practice Address - Country:US
Practice Address - Phone:503-675-4141
Practice Address - Fax:503-675-4200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)