Healthcare Provider Details

I. General information

NPI: 1497460976
Provider Name (Legal Business Name): KATELYN MAGNAN IVERSON LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2023
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 COON RAPIDS BLVD NW STE 100
COON RAPIDS MN
55433-5869
US

IV. Provider business mailing address

5730 EMERSON AVE N
BROOKLYN CENTER MN
55430-2657
US

V. Phone/Fax

Practice location:
  • Phone: 651-240-2206
  • Fax: 612-446-5766
Mailing address:
  • Phone: 763-516-0535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5145
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: