Provider Demographics
NPI:1861174757
Name:FERNDALE UNIFIED SCHOOL DISTRICT
Entity type:Organization
Organization Name:FERNDALE UNIFIED SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAHM
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:707-845-4028
Mailing Address - Street 1:164 SHAW AVE
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95536-9781
Mailing Address - Country:US
Mailing Address - Phone:707-786-5300
Mailing Address - Fax:
Practice Address - Street 1:164 SHAW AVE
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:CA
Practice Address - Zip Code:95536-9781
Practice Address - Country:US
Practice Address - Phone:707-786-5300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)