Doctor Name: | MRS. SHEILA MARIE IVERSON |
NPI Number: | 1215147863 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LADC |
License Number: | 301055 |
Business Practice Address: | 351 Terrace View Dr Litchfield, MN - 553552532 |
Business Phone Number: | 3205354127 |
Business Fax Number: | |
Mailing Address: | 351 Terrace View Dr, LITCHFIELD |
State: | MN |
Postal Code: | 55355 |
Phone Number: | 3205354127 |
Fax Number: | |
NPI Enumeration Date: | 05/23/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 301055 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |