Provider Demographics
NPI:1851649388
Name:SOUTH MACOUPIN ASSOCIATION FOR SPECIAL EDUCATION
Entity type:Organization
Organization Name:SOUTH MACOUPIN ASSOCIATION FOR SPECIAL EDUCATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SPECIAL EDUCATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:
Authorized Official - Last Name:STORM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-635-8230
Mailing Address - Street 1:701 N DENEEN ST
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:IL
Mailing Address - Zip Code:62088-1015
Mailing Address - Country:US
Mailing Address - Phone:618-635-8230
Mailing Address - Fax:618-635-4637
Practice Address - Street 1:701 N DENEEN ST
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:IL
Practice Address - Zip Code:62088-1015
Practice Address - Country:US
Practice Address - Phone:618-635-8230
Practice Address - Fax:618-635-4637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)