Watershed High School

Primary specialty

Local Education Agency (LEA)Taxonomy code 251300000X

License

22317 Issued in MN

Legal business name

WATERSHED HIGH SCHOOL

Practice address

6541 16TH Ave S
Richfield, MN 55423-1751

Phone

(612) 871-4363

NPI assigned

Jan 28, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Destiny Sparks

Title

Executive Director

Phone

(952) 649-0485

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1422403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422403200000",
    "number": "1154711216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6541 16TH AVE S",
            "city": "RICHFIELD",
            "state": "MN",
            "postal_code": "554231751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6541 16TH AVE S",
            "city": "RICHFIELD",
            "state": "MN",
            "postal_code": "554231751",
            "telephone_number": "612-871-4363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERSHED HIGH SCHOOL",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-28",
        "last_updated": "2015-01-28",
        "status": "A",
        "authorized_official_last_name": "SPARKS",
        "authorized_official_first_name": "DESTINY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "952-649-0485"
    },
    "taxonomies": [
        {
            "code": "251300000X",
            "taxonomy_group": "",
            "desc": "Local Education Agency (LEA)",
            "state": "MN",
            "license": "22317",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carrie Walton, RN, DDS
• Kalsang Wangmo
• Dylan Ward
• Justin Ward
• Omar Warfa
• Aspen Lee Watson
• Krista Weber
• Jordyn Webster
• Kimberly Yvette Weems
• Welcome Home LLC

• Local Education Agency (LEA) in Richfield, MN
• Providers in Richfield, MN by specialty
• Local Education Agency (LEA) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.