Integrated Intervention Specialists, LLC
Organization Active NPI Community/Behavioral Health Agency · Fargo, ND
NPI 1275194136 · NPPES record last updated Feb 1, 2025
Key facts
- NPI
- 1275194136
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Behavioral Health Agency 251S00000X
- Legal business name
- INTEGRATED INTERVENTION SPECIALISTS, LLC
- Practice address
- 4215 31St Ave S Ste a
Fargo, ND 58104-7743 - Phone
- (701) 478-0221
- Fax
- (701) 478-0222
- NPI assigned
- Jun 21, 2019
- Organization subpart
- No
Authorized official
- Name
- Jaclyn Martinson
- Title
- Owner
- Phone
- (701) 341-6025
Subparts reporting this organization as parent 1
Corporate family (same tax ID) 1
Practitioners 38
-
Justin James Boseck, PH.D.
-
Nicholas David Schulz, OTR/L
-
Kayla Stroh, OT
-
Kelly R Boyden, RBT
-
Marissa Rae Piasecki, RBT
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ND
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230630001440 | ND | Part B Supplier - Clinic/Group Practice | 1557720059 |
Receives reassigned benefits from 4 practitioners Practice locations: Fargo, ND |
National Provider Directory
- Tax ID family
- Integrated Intervention Specialists LLC
Locations
4725 Amber Valley Pkwy S
#B
Fargo, ND 58104
Phone (701) 478-0221
4215 31st Ave S
Ste A
Fargo, ND 58104
Phone (701) 478-0221
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | Yes | ||
| Hearing and Speech Clinic/Center | 261QH0700X |
Addresses
Primary practice location
4215 31St Ave S Ste a
Fargo, ND 58104-7743
Mailing address
4215 31St Ave S Ste a
Fargo, ND 58104-7743
Phone (701) 478-0221
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538310792 | Medicaid | ND |
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All providers in Fargo, ND · Community/Behavioral Health Agency in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 1, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.