Wolverine Academy, LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

942851 Issued in AK

Legal business name

WOLVERINE ACADEMY, LLC

Practice address

15700 E Clark Rd
Palmer, AK 99645-8705

Phone

(907) 746-3442

Fax

(907) 746-4847

NPI assigned

Mar 17, 2011

Organization subpart

No

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

Authorized official

Name

Mrs. Kelly Ann Barrett-Godwin

Title

Owner/Designee

Phone

(907) 746-3442

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1300320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300320000000",
    "number": "1881993749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15700 E CLARK RD",
            "city": "PALMER",
            "state": "AK",
            "postal_code": "996458705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15700 E CLARK RD",
            "city": "PALMER",
            "state": "AK",
            "postal_code": "996458705",
            "telephone_number": "907-746-3442",
            "fax_number": "907-746-4847"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOLVERINE ACADEMY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-17",
        "last_updated": "2011-03-17",
        "status": "A",
        "authorized_official_last_name": "BARRETT-GODWIN",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER/DESIGNEE",
        "authorized_official_telephone_number": "907-746-3442",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "AK",
            "license": "942851",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Wixson, FNP
• Emmy Wolber, COTA
• Kristin W. Wolf
• Amanda Leigh Wolfe, LPC, RPT, CDC 1
• Elizabeth A Wolfe
• Kirsten Woodard, OTR/L
• Alison Woodings, MT
• Alexia Wright
• Kimberly Ann Wright, DPT
• James Matthew Wyss, PTA

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Palmer, AK
• Providers in Palmer, AK by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2011; 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.