# NORTHWAY ACADEMY, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073181350
- **Authorized official:** MARY PATRICIA RODENBERG-ROBERTS (VICE PRES & SR ASST GENERAL COUNSEL)
- **Authorized official phone:** (952) 836-2234

## Contact information

- **Practice address:** 109 DOCTORS PARK, ST. CLOUD, MN 56303-1207
- **Practice address phone:** (320) 774-1908
- **Practice address fax:** (952) 945-4918
- **Mailing address:** 6600 FRANCE AVE S STE 350, EDINA, MN 55435-1810
- **Mailing address phone:** (952) 563-2207
- **Mailing address fax:** (952) 922-6885

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD1600X | Developmental Disabilities Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 06/14/2021
- **Last updated:** 01/23/2024