MEDICARE: INTEGRATIVE LIFE SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1285597823
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATIVE LIFE SERVICES LLC

Provider Business Mailing Address
First Line	:	416 S GRANT ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80209-1727
Country	:	US
Telephone Number	:	303-514-3592
Fax Number	:

Provider Business Practice Location Address
First Line	:	1711 S PEARL ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-3184
Country	:	US
Telephone Number	:	303-482-2026
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ERICA VIGGIANO
Credential	:	LCSW
Telephone Number	:	303-482-2026

Provider Enumeration Date	:	12/09/2025
Last Update Date	:	12/09/2025

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