| Illume North, Llc | |
|
324 W Superior St 630 Medical Arts Duluth MN 55802-1701 | |
| (218) 380-7119 | |
| (651) 925-0039 |
| Full Name | Illume North, Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 324 W Superior St, Duluth, Minnesota |
| Authorized Official Name and Position | Sara Vaccarella (PRESIDENT) |
| Authorized Official Contact | 2183024678 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Illume North, Llc 324 W Superior St # 630 Duluth MN 55802-1701 Ph: (218) 380-7119 | Illume North, Llc 324 W Superior St 630 Medical Arts Duluth MN 55802-1701 Ph: (218) 380-7119 |
| NPI Number | 1639789019 |
|---|---|
| Provider Enumeration Date | 07/31/2020 |
| Last Update Date | 02/01/2021 |
| Certification Date | 02/01/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639789019 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Secondary |
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