Healthcare Provider Details

I. General information

NPI: 1194881433
Provider Name (Legal Business Name): NORTHWOOD CHILDREN'S HOME SOCIETY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 W 9TH ST
DULUTH MN
55807-1563
US

IV. Provider business mailing address

4000 W 9TH ST
DULUTH MN
55807-1563
US

V. Phone/Fax

Practice location:
  • Phone: 218-625-2669
  • Fax: 218-625-2698
Mailing address:
  • Phone: 218-625-2669
  • Fax: 218-625-2698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. MELISSA WINKLER
Title or Position: DIRECTOR OF QUALITY ASSURANCE
Credential: LICSW
Phone: 218-625-2638