Provider Demographics
NPI:1174688691
Name:NORTHLAND LEARNING CENTER
Entity Type:Organization
Organization Name:NORTHLAND LEARNING CENTER
Other - Org Name:NORTHLAND SPECIAL EDUCATION COOPERATIVE
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF SPECIAL EDUCATION
Authorized Official - Prefix:MS
Authorized Official - First Name:REGGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGEBRITSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-741-5284
Mailing Address - Street 1:1201 S 13TH AVE
Mailing Address - Street 2:PO BOX 1286
Mailing Address - City:VIRGINIA
Mailing Address - State:MN
Mailing Address - Zip Code:55792-3361
Mailing Address - Country:US
Mailing Address - Phone:218-741-5284
Mailing Address - Fax:218-741-5384
Practice Address - Street 1:1201 S 13TH AVE
Practice Address - Street 2:
Practice Address - City:VIRGINIA
Practice Address - State:MN
Practice Address - Zip Code:55792-3361
Practice Address - Country:US
Practice Address - Phone:218-741-5284
Practice Address - Fax:218-741-5384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN726100400OtherMN-ITS USER ID