| Organization Name: | NORTHERN LAKES CLINIC, INC. |
| NPI Number: | 1114071420 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LOIS COCHRANE SCHLUTTER (CEO & OWNER) |
| Mailing Address: | 301 America Ave Nw Bemidji |
| State: | MN US |
| Postal Code: | 566013120 |
| Phone Number: | 2187555170 |
| Fax Number: | 2187511194 |
| NPI Enumeration Date: | 01/23/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0405X |
| License Number: | 1045771-1-CDT |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rehabilitation, Substance Use Disorder |
| Taxonomy Definition: | |