Healthcare Provider Details

I. General information

NPI: 1134037732
Provider Name (Legal Business Name): IGNITE THERAPEUTIC SERVICES, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 W NATIONAL AVE
MILWAUKEE WI
53204-1347
US

IV. Provider business mailing address

14027 LYNCH DR
ROGERS MN
55374-5828
US

V. Phone/Fax

Practice location:
  • Phone: 920-393-8320
  • Fax:
Mailing address:
  • Phone: 763-228-4344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ABBY HANSEN
Title or Position: OWNER
Credential: SLP
Phone: 920-393-8320