Healthcare Provider Details

I. General information

NPI: 1588948723
Provider Name (Legal Business Name): NORTHERN INTEGRATED HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2011
Last Update Date: 10/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12450 WAYZATA BLVD STE 107
MINNETONKA MN
55305-1926
US

IV. Provider business mailing address

12450 WAYZATA BLVD STE 107
MINNETONKA MN
55305-1926
US

V. Phone/Fax

Practice location:
  • Phone: 952-545-4241
  • Fax:
Mailing address:
  • Phone: 952-545-4241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. LOIS SCHLUTTER
Title or Position: OWNER/OPERATER
Credential:
Phone: 952-548-9340