1669860193 NPI number — COOPERATIVE EDUCATIONAL SERVICE AGENCY 2

Table of content: (NPI 1669860193)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669860193 NPI number — COOPERATIVE EDUCATIONAL SERVICE AGENCY 2

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COOPERATIVE EDUCATIONAL SERVICE AGENCY 2
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:
6
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:
1669860193
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1221 INNOVATION DRIVE
Provider Second Line Business Mailing Address:
SUITE 205
Provider Business Mailing Address City Name:
WHITEWATER
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53190
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-473-1473
Provider Business Mailing Address Fax Number:
262-472-2269

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17 S RIVER STREET
Provider Second Line Business Practice Location Address:
#100
Provider Business Practice Location Address City Name:
JANESVILLE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-741-6687
Provider Business Practice Location Address Fax Number:
608-756-1288
Provider Enumeration Date:
01/06/2015

Additional Information

Authorized Official

Authorized Official Last Name:
BARLASS
Authorized Official First Name:
NICOLE
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR OF OPERATIONS
Authorized Official Telephone Number:
262-473-1447

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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