Healthcare Provider Details

I. General information

NPI: 1265671531
Provider Name (Legal Business Name): CARLETON COLLEGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2009
Last Update Date: 02/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 N COLLEGE ST
NORTHFIELD MN
55057-4001
US

IV. Provider business mailing address

1 N COLLEGE ST
NORTHFIELD MN
55057-4001
US

V. Phone/Fax

Practice location:
  • Phone: 507-222-4080
  • Fax: 507-222-5038
Mailing address:
  • Phone: 507-222-4080
  • Fax: 507-222-5038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CATHLEEN CARLSON
Title or Position: DIRECTOR OF THE WELLNESS CENTER
Credential:
Phone: 507-222-4080