Provider Demographics
NPI:1528025954
Name:INTEGRATED DEVELOPMENTAL SERVICES, INC
Entity Type:Organization
Organization Name:INTEGRATED DEVELOPMENTAL SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MORAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-954-9128
Mailing Address - Street 1:1575 ALLOUEZ AVE
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-5639
Mailing Address - Country:US
Mailing Address - Phone:920-857-9041
Mailing Address - Fax:920-857-3366
Practice Address - Street 1:559 ZOR SHRINE PLACE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719
Practice Address - Country:US
Practice Address - Phone:608-441-0123
Practice Address - Fax:608-441-0126
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARAVEL AUTISM HEALTH, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-28
Last Update Date:2019-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty