Organization
CROW WING & CASS COS IND SCHOOL DIST NO 186
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WANDA LANE (THIRD PARTY ADMINISTRATOR)
(218) 454-5532
Entity
Organization
Contact information
Practice address
30805 OLSON ST, PEQUOT LAKES, MN 56472-3094
(218) 568-4996
Mailing address
804 OAK STREET, BRAINERD, MN 56401
Taxonomy
Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
487463300
—
MN
Enumeration date
10/05/2006
Last updated
11/12/2020
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