Provider Demographics
NPI:1902105042
Name:MEXICO ACADEMY AND CENTRAL SCHOOL DISTRICT
Entity Type:Organization
Organization Name:MEXICO ACADEMY AND CENTRAL SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JACALYN
Authorized Official - Middle Name:N
Authorized Official - Last Name:BATES
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:315-334-2845
Mailing Address - Street 1:16 FRAVOR RD
Mailing Address - Street 2:
Mailing Address - City:MEXICO
Mailing Address - State:NY
Mailing Address - Zip Code:13114-3011
Mailing Address - Country:US
Mailing Address - Phone:315-963-8400
Mailing Address - Fax:
Practice Address - Street 1:16 FRAVOR RD
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:NY
Practice Address - Zip Code:13114-3011
Practice Address - Country:US
Practice Address - Phone:315-963-8400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01366949Medicaid