Organization
SOUTH FORK SCHOOL DIST #14
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WENDY DULAKIS (BOOKKEEPER)
(217) 237-4331
Entity
Organization
Contact information
Practice address
550 PRAIRIE STREET, KINCAID, IL 62540-0020
(217) 237-4331
(217) 237-2245
Mailing address
PO BOX 20, KINCAID, IL 62540-0020
(217) 237-4331
(217) 237-2245
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1001101014024
—
IL
Enumeration date
06/30/2015
Last updated
06/30/2015
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