Organization
MINOCQUA J1
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JIM ELLIS (DISTRICT ADMINISTRATOR)
(715) 356-5206
Entity
Organization
Contact information
Practice address
7450 TITUS DR, MINOCQUA, WI 54548-9139
(715) 356-5206
(715) 358-2649
Mailing address
7450 TITUS DR, MINOCQUA, WI 54548-9139
(715) 356-5206
(715) 358-2649
Taxonomy
Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
44225800
—
WI
Enumeration date
10/31/2007
Last updated
10/31/2007
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