Provider Demographics
NPI:1699190405
Name:STATE OF MINNESOTA
Entity type:Organization
Organization Name:STATE OF MINNESOTA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:MACKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-279-4160
Mailing Address - Street 1:6125 OLSON MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4918
Mailing Address - Country:US
Mailing Address - Phone:763-279-4200
Mailing Address - Fax:763-591-4646
Practice Address - Street 1:6125 OLSON MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-4918
Practice Address - Country:US
Practice Address - Phone:763-279-4200
Practice Address - Fax:763-591-4646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-03
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)