| Integrated Intervention Specialists, Llc | |
|
4215 31st Ave S Ste A Fargo ND 58104-7743 | |
| (701) 478-0221 | |
| (701) 478-0222 |
| Full Name | Integrated Intervention Specialists, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 4215 31st Ave S Ste A, Fargo, North Dakota |
| Authorized Official Name and Position | Jaclyn Martinson (OWNER) |
| Authorized Official Contact | 7013416025 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Integrated Intervention Specialists, Llc 4215 31st Ave S Ste A Fargo ND 58104-7743 Ph: (701) 478-0221 | Integrated Intervention Specialists, Llc 4215 31st Ave S Ste A Fargo ND 58104-7743 Ph: (701) 478-0221 |
| NPI Number | 1275194136 |
|---|---|
| Provider Enumeration Date | 06/21/2019 |
| Last Update Date | 02/01/2025 |
| Certification Date | 02/01/2025 |
| Medicare PECOS PAC ID | 1557720059 |
|---|---|
| Medicare Enrollment ID | O20230630001440 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275194136 | NPI | - | NPPES |
| 1538310792 | Medicaid | ND |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| 261QH0700X | Clinic/center - Hearing And Speech | (* (Not Available)) | Secondary |
| Provider Name | Nicholas David Schulz |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1891274890 PECOS PAC ID: 7214396159 Enrollment ID: I20230710002896 |
| Provider Name | Rachel Haman |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1538310792 PECOS PAC ID: 0547629040 Enrollment ID: I20230713004084 |
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