Wingspan Life Resources

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

License

HFID 01198 Issued in MN

Legal business name

WINGSPAN LIFE RESOURCES

Practice address

30 Plato Blvd E
Saint Paul, MN 55107-1809

Phone

(651) 242-5840

NPI assigned

Jan 8, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Therese G Davis

Title

Executive Director

Phone

(651) 242-5840

Specialties & licenses 2

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1561334400000",
    "number": "1871641373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 PLATO BLVD E",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551071809",
            "telephone_number": "651-242-5840",
            "fax_number": "651-646-2347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 PLATO BLVD E",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551071809",
            "telephone_number": "651-242-5840"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1846 Dayton Ave",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "551046012",
            "country_code": "US",
            "telephone_number": "651-646-3846",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1846 Portland Ave",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "551046062",
            "country_code": "US",
            "telephone_number": "651-646-3846",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WINGSPAN LIFE RESOURCES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "last_updated": "2019-06-24",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "THERESE",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "651-242-5840",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "MN",
            "license": "HFID 01198",
            "primary": true
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "MN",
            "license": "HFID 01287",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ICFMR - 91ST STR",
            "identifier": "014245000",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ICFMR - MARSHALL",
            "identifier": "047148000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Candice Wilt
• Abbey Lynn Wiltzius, LAMFT
• Natalie Elise Wimmer
• Sharon Windorski
• Window Concepts of Minnesota Inc
• Ann Marie Clark Miller Winskowski, PSYD
• Willie Winston III, PHD
• Jill Christine Winter, LICSW
• Lisa Winter, R.D.
• Thomas Ward Winter, MD

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.