Healthcare Provider Details

I. General information

NPI: 1073456273
Provider Name (Legal Business Name): MRS. JESSICA CHRISTINE IVERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 SW SILVER LAKE BLVD
BEND OR
97702-2194
US

IV. Provider business mailing address

1110 SW SILVER LAKE BLVD
BEND OR
97702-2194
US

V. Phone/Fax

Practice location:
  • Phone: 303-335-5832
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: