Provider Demographics
NPI:1255434130
Name:GILBERT CSD
Entity type:Organization
Organization Name:GILBERT CSD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOHNA
Authorized Official - Middle Name:S
Authorized Official - Last Name:CLANCY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-232-3740
Mailing Address - Street 1:103 MATHEWS DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:IA
Mailing Address - Zip Code:50105-1017
Mailing Address - Country:US
Mailing Address - Phone:515-232-3740
Mailing Address - Fax:
Practice Address - Street 1:103 MATHEWS DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:IA
Practice Address - Zip Code:50105-1017
Practice Address - Country:US
Practice Address - Phone:515-232-3740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0256404Medicaid