| Iron Range Behavioral Services, Llc | |
|
910 8th St S Ste B Virginia MN 55792-3236 | |
| (218) 748-8500 | |
| (218) 748-8501 |
| Full Name | Iron Range Behavioral Services, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 910 8th St S Ste B, Virginia, Minnesota |
| Authorized Official Name and Position | Mark F Wicker (PRESIDENT) |
| Authorized Official Contact | 2183418523 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Iron Range Behavioral Services, Llc Po Box 236 Cotton MN 55724-0236 Ph: (218) 341-8523 | Iron Range Behavioral Services, Llc 910 8th St S Ste B Virginia MN 55792-3236 Ph: (218) 748-8500 |
| NPI Number | 1851900484 |
|---|---|
| Provider Enumeration Date | 07/29/2020 |
| Last Update Date | 06/04/2024 |
| Certification Date | 06/04/2024 |
| Medicare PECOS PAC ID | 1456756352 |
|---|---|
| Medicare Enrollment ID | O20210816001322 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851900484 | NPI | - | NPPES |
| Provider Name | Julie K Wicker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548337173 PECOS PAC ID: 3779563879 Enrollment ID: I20040721000065 |
| Provider Name | Lisa M Haberling |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740666221 PECOS PAC ID: 9436466307 Enrollment ID: I20150910001104 |
| Provider Name | Joni C Deetz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1063882520 PECOS PAC ID: 4183924236 Enrollment ID: I20151123001115 |
| Provider Name | Amy J Wicker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902198088 PECOS PAC ID: 4284819335 Enrollment ID: I20180228003027 |
| Provider Name | Brenda J Caya |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1306336516 PECOS PAC ID: 5799032868 Enrollment ID: I20180719003460 |
| Provider Name | Leah M Zook |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477037711 PECOS PAC ID: 3375897952 Enrollment ID: I20181117000385 |
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