1023035870 NPI number — COUNCIL BLUFFS COMMUNITY SCHOOL DISTRICT

Table of content: RYANN MARIE HELLER MA, CCC, SLP (NPI 1508383555)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023035870 NPI number — COUNCIL BLUFFS COMMUNITY SCHOOL DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNCIL BLUFFS COMMUNITY SCHOOL DISTRICT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023035870
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12 SCOTT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COUNCIL BLUFFS
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51503-0782
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-328-6400
Provider Business Mailing Address Fax Number:
712-328-6488

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12 SCOTT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COUNCIL BLUFFS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51503-0782
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-328-6400
Provider Business Practice Location Address Fax Number:
712-328-6488
Provider Enumeration Date:
07/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DIIMIG
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
J
Authorized Official Title or Position:
SUPERVISOR OF STUDENT SERVICES
Authorized Official Telephone Number:
712-328-6430

Provider Taxonomy Codes

  • Taxonomy code: 251300000X , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0248666 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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