Provider Demographics
NPI:1437339306
Name:EDUCATIONAL SERVICE DISTRICT 123
Entity type:Organization
Organization Name:EDUCATIONAL SERVICE DISTRICT 123
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PREVENTION & TREATMENT CENTER DIREC
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:LOIS
Authorized Official - Last Name:SHEPHERD
Authorized Official - Suffix:
Authorized Official - Credentials:CDP
Authorized Official - Phone:509-544-5761
Mailing Address - Street 1:3918 W COURT ST
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-2775
Mailing Address - Country:US
Mailing Address - Phone:509-544-5761
Mailing Address - Fax:509-543-3328
Practice Address - Street 1:3918 W COURT ST
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-2775
Practice Address - Country:US
Practice Address - Phone:509-544-5761
Practice Address - Fax:509-543-3328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA11135800251S00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty