Provider Demographics
NPI:1275194136
Name:INTEGRATED INTERVENTION SPECIALISTS, LLC
Entity Type:Organization
Organization Name:INTEGRATED INTERVENTION SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:ERIN
Authorized Official - Last Name:HAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-799-2045
Mailing Address - Street 1:4725 AMBER VALLEY PKWY S STE B
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8614
Mailing Address - Country:US
Mailing Address - Phone:701-478-0221
Mailing Address - Fax:
Practice Address - Street 1:4725 AMBER VALLEY PKWY S STE B
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8614
Practice Address - Country:US
Practice Address - Phone:701-478-0221
Practice Address - Fax:701-478-0222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-21
Last Update Date:2023-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1538310792Medicaid