Healthcare Provider Details

I. General information

NPI: 1184538456
Provider Name (Legal Business Name): ADVANCE TOGETHER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11043 NASSAU CIR NE
BLAINE MN
55449-5489
US

IV. Provider business mailing address

11043 NASSAU CIR NE
BLAINE MN
55449-5489
US

V. Phone/Fax

Practice location:
  • Phone: 612-735-0775
  • Fax: 614-818-5505
Mailing address:
  • Phone: 612-735-0775
  • Fax: 614-818-5505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. PATRICIA ANN HERRBOLDT
Title or Position: OWNER
Credential:
Phone: 612-735-0775