Provider Demographics
NPI:1689810046
Name:SCHOOL DISTRICT 64 PARK RIDGE/NILES, IL
Entity type:Organization
Organization Name:SCHOOL DISTRICT 64 PARK RIDGE/NILES, IL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL OF EMERSON MIDDLE SCHOOL
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOGIL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD IN EDUCATION
Authorized Official - Phone:1847-318-8110
Mailing Address - Street 1:8101 N CUMBERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-2736
Mailing Address - Country:US
Mailing Address - Phone:847-318-8713
Mailing Address - Fax:847-318-8701
Practice Address - Street 1:1731 PAVILION WAY UNIT 207
Practice Address - Street 2:#207
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1190
Practice Address - Country:US
Practice Address - Phone:847-899-8284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1500050621041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL150005062OtherSTATE OF ILLINOIS DEPT. OF REGISTRATION SOCIAL WORK