Provider Demographics
NPI:1710250154
Name:COLOGNE ACADEMY
Entity Type:Organization
Organization Name:COLOGNE ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:GLUCK PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-466-2276
Mailing Address - Street 1:1221 VILLAGE PKWY
Mailing Address - Street 2:
Mailing Address - City:COLOGNE
Mailing Address - State:MN
Mailing Address - Zip Code:55322-9248
Mailing Address - Country:US
Mailing Address - Phone:952-466-2276
Mailing Address - Fax:952-466-4030
Practice Address - Street 1:1221 VILLAGE PKWY
Practice Address - Street 2:
Practice Address - City:COLOGNE
Practice Address - State:MN
Practice Address - Zip Code:55322-9248
Practice Address - Country:US
Practice Address - Phone:952-466-2276
Practice Address - Fax:952-466-4030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)