Healthcare Provider Details

I. General information

NPI: 1639789019
Provider Name (Legal Business Name): ILLUME NORTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2020
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 W SUPERIOR ST STE 601
DULUTH MN
55802-5016
US

IV. Provider business mailing address

306 W SUPERIOR ST STE 601
DULUTH MN
55802-5016
US

V. Phone/Fax

Practice location:
  • Phone: 218-522-4469
  • Fax:
Mailing address:
  • Phone: 218-522-4469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. SARA BOVEE
Title or Position: OWNER
Credential: PSY.D.
Phone: 218-522-4469