Healthcare Provider Details

I. General information

NPI: 1649311655
Provider Name (Legal Business Name): INTEGRATED MENTAL HEALTH SERVICE, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 MAIN ST
MARINETTE WI
54143-1806
US

IV. Provider business mailing address

PO BOX 1197
MARINETTE WI
54143-6197
US

V. Phone/Fax

Practice location:
  • Phone: 715-735-9536
  • Fax:
Mailing address:
  • Phone: 715-735-9536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6159
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number35255-020
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number32903
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35255-020
License Number StateWI

VIII. Authorized Official

Name: KATRIN JENSEN
Title or Position: OFFICE MANAGER
Credential:
Phone: 715-735-9536