Provider Demographics
NPI:1699956607
Name:COOPERATIVE EDUCATIONAL SERVICE AGENCY NO 8
Entity type:Organization
Organization Name:COOPERATIVE EDUCATIONAL SERVICE AGENCY NO 8
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:VIEGUT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:920-855-2114
Mailing Address - Street 1:223 W PARK STREET
Mailing Address - Street 2:
Mailing Address - City:GILLETT
Mailing Address - State:WI
Mailing Address - Zip Code:54124
Mailing Address - Country:US
Mailing Address - Phone:920-855-2114
Mailing Address - Fax:920-855-2299
Practice Address - Street 1:223 W PARK STREET
Practice Address - Street 2:
Practice Address - City:GILLETT
Practice Address - State:WI
Practice Address - Zip Code:54124
Practice Address - Country:US
Practice Address - Phone:920-855-2114
Practice Address - Fax:920-855-2299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3675-125101YM0800X
WI3840-125101YP2500X
WI970-57103TC1900X
WI251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251300000XAgenciesLocal Education Agency (LEA)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44200600Medicaid