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Organization
EDUCATIONAL SERVICE DISTRICT 112
Active
Organization
EDUCATIONAL SERVICE DISTRICT 112
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GAVIN HOTTMAN (BUDGET ANALYST)
(360) 750-7500
Entity
Organization
Contact information
Practice address
2500 NE 65 AVENUE, VANCOUVER, WA 98661-6812
(360) 750-7500
(360) 906-1010
Mailing address
2500 NE 65 AVENUE, VANCOUVER, WA 98661-6812
(360) 750-7500
(360) 906-1010
Taxonomy
Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
—
—
251B00000X
Case Management Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1996008
CURRENT PROVIDER NUMBER TO BE USED WITH NPI
WA
Enumeration date
03/02/2010
Last updated
11/24/2020
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