Provider Demographics
NPI:1871785931
Name:KEWASKUM SCHOOL DISTRICT
Entity type:Organization
Organization Name:KEWASKUM SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PUPIL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-626-8427
Mailing Address - Street 1:PO BOX 37
Mailing Address - Street 2:
Mailing Address - City:KEWASKUM
Mailing Address - State:WI
Mailing Address - Zip Code:53040-0037
Mailing Address - Country:US
Mailing Address - Phone:262-626-8427
Mailing Address - Fax:262-626-2961
Practice Address - Street 1:1676 REIGLE DR STE 100
Practice Address - Street 2:
Practice Address - City:KEWASKUM
Practice Address - State:WI
Practice Address - Zip Code:53040-8923
Practice Address - Country:US
Practice Address - Phone:262-626-8427
Practice Address - Fax:262-626-2961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44214100Medicaid