Healthcare Provider Details

I. General information

NPI: 1710859285
Provider Name (Legal Business Name): NORTHWAY ACADEMY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2025
Last Update Date: 09/23/2025
Certification Date: 09/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1884 EAST RUM RIVER DRIVE SOUTH
CAMBRIDGE MN
55008
US

IV. Provider business mailing address

6600 FRANCE AVE S STE 350
EDINA MN
55435-1810
US

V. Phone/Fax

Practice location:
  • Phone: 763-689-5385
  • Fax: 763-328-2782
Mailing address:
  • Phone: 800-388-5150
  • Fax: 952-922-6885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARY PATRICIA RODENBERG-ROBERTS
Title or Position: VP & SR ASST. GENERAL COUNSEL
Credential:
Phone: 952-836-2234