Independent Disability Services

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

1047172 Issued in MN

Legal business name

INDEPENDENT DISABILITY SERVICES

Practice address

1201 5TH Ave SE
Little Falls, MN 56345-3342

Phone

(320) 632-2674

NPI assigned

May 24, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tanya Marie Derosier

Title

Program Manager

Phone

(320) 632-2674

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1093926099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 5TH AVE SE",
            "city": "LITTLE FALLS",
            "state": "MN",
            "postal_code": "563453342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 5TH AVE SE",
            "city": "LITTLE FALLS",
            "state": "MN",
            "postal_code": "563453342",
            "telephone_number": "320-632-2674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENT DISABILITY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DEROSIER",
        "authorized_official_first_name": "TANYA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "PROGRAM MANAGER",
        "authorized_official_telephone_number": "320-632-2674"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "MN",
            "license": "1047172",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leighanne H Houserman, MD
• Mary Hroscikoski, M.D.
• Gregory George Hubbard, DDS
• Sarah Marie Wilm Hunter, CNP
• Marilyn Husby, APRN, CNP, FNP-BC
• Kristin Jackson, D.P.M.
• Brittney Jelinski
• JMBB, LLC
• Derek Paul Johnson, DPT
• Jacquelyn Lee Johnson, C.N.P.

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Little Falls, MN
• Providers in Little Falls, MN by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.