Healthcare Provider Details

I. General information

NPI: 1538198361
Provider Name (Legal Business Name): SPECIALIZED VOCATIONAL SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 10TH ST
WORTHINGTON MN
56187-2316
US

IV. Provider business mailing address

320 10TH ST P.O. BOX 451
WORTHINGTON MN
56187-2316
US

V. Phone/Fax

Practice location:
  • Phone: 507-376-3550
  • Fax: 507-376-6412
Mailing address:
  • Phone: 507-376-3550
  • Fax: 507-376-6412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number1021018-1-WS
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number1021018-1-WS
License Number StateMN

VIII. Authorized Official

Name: TAMMY BOURQUIN
Title or Position: ADMINISTATION COORDINATOR
Credential:
Phone: 507-376-3550