ILLUME NORTH, LLC (NPI# 1639789019) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639789019 |
| Entity Type | Organization |
| Organization Name | ILLUME NORTH, LLC |
| Practice Address |
324 W Superior St 630 Medical Arts Duluth MN 55802-1701 |
| Mailing Address |
324 W Superior St # 630 Duluth MN 55802-1701 |
| Practice Telephone | 2183807119 |
| Practice Fax Number | 6519250039 |
| Mailing Telephone | 2183807119 |
| Mailing Fax Number | 6519250039 |
| Enumeration Date | 2020-07-31 |
| Last Update Date | 2020-07-31 |
| Authorized Official Name | SARA VACCARELLA (PRESIDENT) |
| Authorized Official Telephone | 2183807119 |
| Authorized Official Credential | PSYD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
Behavioral Health & Social Service Providers |
| Street Address |
324 W SUPERIOR ST 630 MEDICAL ARTS |
| City | DULUTH |
| State | MN |
| Zip Code | 55802-1701 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073517447 | Eileen E. Patterson | Dentist | 324 W Superior St, Ste 1130, Duluth, MN 55802-1714 | 2005-06-13 |
| 1669087797 | Center for Family Wellness | Marriage & Family Therapist | 324 W Superior St, 828 Medical Arts Building, Duluth, MN 55802-1701 | 2020-09-15 |
| 1861038176 | Erin Elizabeth Devaney Therrien | Social Worker | 324 W Superior St, Duluth, MN 55802-1701 | 2019-11-21 |
| 1316430002 | Paul Raymond Baecker | Counselor | 324 W Superior St, Duluth, MN 55802-1701 | 2018-06-07 |
| 1194275537 | Andrea Wells | Counselor | 324 W Superior St, Duluth, MN 55802-1701 | 2016-10-10 |
| 1215480660 | North Shore Mental Health Services LLC | Counselor | 324 W Superior St, Suite 911, Duluth, MN 55802-1701 | 2016-08-02 |
| 1518321710 | Nathan G Halstead Dds Ms PC | Dentist | 324 W Superior St, Suite 100, Duluth, MN 55802-1701 | 2016-04-13 |
| 1740669704 | Northwoods Counseling Center LLC | Psychologist | 324 W Superior St, Suite 911, Duluth, MN 55802-1701 | 2015-05-23 |
| 1134522527 | Adam Ries | Psychologist | 324 W Superior St, Suite 600, Duluth, MN 55802-1701 | 2014-09-30 |
| 1780014589 | Robin Barrett | Social Worker | 324 W Superior St, Ste 300, Duluth, MN 55802-1701 | 2013-11-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063915239 | Jpw Counseling & Consultation | Social Worker | 302 W Superior St Ste 508, Duluth, MN 55802 | 2018-03-14 |
| 1134664311 | Amp Group, LLC | Counselor | 331 West Superior Street, Duluth, MN 55802 | 2016-12-27 |
| 1982151361 | Tiffany Riester | Counselor | 332 W Superior Street, Suite 300, Duluth, MN 55802 | 2016-09-02 |
| 1730635392 | Karina Krosbakken | Counselor | 332 W. Superior St., Suite 300, Duluth, MN 55802 | 2016-09-01 |
| 1437559051 | Natalie R Zwak | Dietitian, Registered | 26 E Superior St Ste 315, Duluth, MN 55802 | 2014-09-02 |
| 1447679279 | Valerie Lou Shelton | Registered Nurse | 118 E Superior St., Duluth, MN 55802 | 2014-04-09 |
| 1285063115 | Brian Bergstedt | Counselor | 332 West Superior Street, Suite 300, Duluth, MN 55802 | 2013-11-01 |
| 1508135948 | Karen Dee Turner | Counselor | 202 W. Superior Street, Suite 700, Duluth, MN 55802 | 2011-12-14 |
| 1497023410 | Jean Barrie Mcbride | Pharmacist | 1131 East Superior Street, Duluth, MN 55802 | 2011-12-05 |
| 1194092304 | Diane Murphy Winship | Pharmacist | 1331 Superior St, Duluth, MN 55802 | 2011-11-17 |
| Find all providers in zip 55802 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053823104 | Laurel June Benoit | Psychologist | 324 W Superior St Ste 300, Duluth, MN 55802-1700 | 2017-10-30 |
| 1124539598 | Jonathan M Beyer | Psychologist | 324 W Superior St Ste 505, Duluth, MN 55802-1725 | 2017-10-12 |
| 1891957890 | Matthew Webb | Psychologist | 530 East Second Street, Duluth, MN 55805-1913 | 2008-06-30 |
| 1548469695 | Elizabeth Gene Burnett | Psychologist | 3305 Breckinridge Blvd Ste 116, Duluth, GA 30096-4932 | 2007-07-17 |
| 1265562755 | Sara Rebecca Dhuse | Psychologist | 4815 Burning Tree Rd Ste 200, Duluth, MN 55811-3833 | 2007-03-06 |
| 1518093640 | Katherine Marie Noonan | Psychologist | 3121 Amesbury Way, Duluth, GA 30096-5861 | 2007-02-25 |
| 1093881187 | Donald E Streufert | Psychologist | 205 West 2nd St, Suite 437 Duluth Psychological Clinic, Duluth, MN 55802 | 2006-11-28 |
| 1306912498 | Richard Ernest Duus | Psychologist | 205 West 2nd Street, Suite 437 Duluth Psychological Clinic, Duluth, MN 55802 | 2006-11-28 |
| 1912995838 | Jane Hovland | Psychologist | 1035 University Dr, 236 Center for Rural Mental Health Studies Med School, Duluth, MN 55812-3031 | 2005-10-13 |
| 1841842150 | Dawn Martinson | Psychologist | 4720 Burning Tree Rd, Duluth, MN 55811-2634 | 2019-07-16 |
| Find all providers in DULUTH | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.