Provider Demographics
NPI:1720672793
Name:NORTH STAR LEARNING AND BEHAVIOR, LLC
Entity Type:Organization
Organization Name:NORTH STAR LEARNING AND BEHAVIOR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHELBY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LP, BCBA-D
Authorized Official - Phone:484-634-6279
Mailing Address - Street 1:112 CHAUCER CT
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-5600
Mailing Address - Country:US
Mailing Address - Phone:507-407-0326
Mailing Address - Fax:
Practice Address - Street 1:112 CHAUCER CT
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-5600
Practice Address - Country:US
Practice Address - Phone:507-407-0326
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-21
Last Update Date:2021-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty