Healthcare Provider Details

I. General information

NPI: 1528922952
Provider Name (Legal Business Name): BROOKE IVERSON MSW, SWC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4820 RUSINA RD STE C
COLORADO SPRINGS CO
80907-8127
US

IV. Provider business mailing address

8722 BITTERCRESS DR
COLORADO SPRINGS CO
80925-9653
US

V. Phone/Fax

Practice location:
  • Phone: 719-354-5378
  • Fax:
Mailing address:
  • Phone: 308-224-7650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWC.0000001866
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: