1700052602 NPI number — RICE LAKE AREA SCHOOL DISTRICT

Table of content: LESLIE M. BAER L.C.S.W. (NPI 1073667036)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700052602 NPI number — RICE LAKE AREA SCHOOL DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICE LAKE AREA 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:
1700052602
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 AUGUSTA STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICE LAKE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54868
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-234-9007
Provider Business Mailing Address Fax Number:
715-234-4552

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 AUGUSTA STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICE LAKE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54868
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-234-9007
Provider Business Practice Location Address Fax Number:
715-234-4552
Provider Enumeration Date:
05/01/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BLACKALLER
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
M
Authorized Official Title or Position:
DIRECTOR OF FINANCE & OPERATIONS
Authorized Official Telephone Number:
715-234-9007

Provider Taxonomy Codes

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

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

  • Identifier: 44219100 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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