Healthcare Provider Details

I. General information

NPI: 1528304136
Provider Name (Legal Business Name): PATHWAYS TO ACHIEVEMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2012
Last Update Date: 04/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2016 W SUPERIOR ST
DULUTH MN
55806-3524
US

IV. Provider business mailing address

114 S 20TH AVE W STE A
DULUTH MN
55806-3526
US

V. Phone/Fax

Practice location:
  • Phone: 187-214-7322
  • Fax: 218-491-7185
Mailing address:
  • Phone: 218-721-4732
  • Fax: 218-491-7185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRENDA EHNES
Title or Position: ADMINISTRATOR
Credential: RN BA MA
Phone: 218-721-4732