Healthcare Provider Details

I. General information

NPI: 1831413442
Provider Name (Legal Business Name): NORTHERN INTEGRATED HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2010
Last Update Date: 03/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 EXCELSIOR BLVD SUITE 202
ST LOUIS PARK MN
55416-2730
US

IV. Provider business mailing address

6200 EXCELSIOR BLVD SUITE 202
ST LOUIS PARK MN
55416-2730
US

V. Phone/Fax

Practice location:
  • Phone: 952-548-9340
  • Fax:
Mailing address:
  • Phone: 952-548-9340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number35122
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number24280
License Number StateMN

VIII. Authorized Official

Name: MS. LOIS COCHRANE SCHLUTTER
Title or Position: PSYCHOLOGIST
Credential:
Phone: 952-548-9340