Healthcare Provider Details

I. General information

NPI: 1952226748
Provider Name (Legal Business Name): INTEGRATE FUNCTIONAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MAIN ST
MARATHON WI
54448-9604
US

IV. Provider business mailing address

234800 DEER CREEK LN
EDGAR WI
54426-5357
US

V. Phone/Fax

Practice location:
  • Phone: 715-391-9671
  • Fax:
Mailing address:
  • Phone: 715-391-9671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: REYNA A IBARRA
Title or Position: HEALTHCARE ADMINISTRATOR
Credential:
Phone: 715-391-9671