MEDICARE: MARGARET MARIE IVERS LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	7004-226	WI
2	101YM0800X	Mental Health Counselor	10904-125	WI

General Provider Information

NPI Number	:	1306575972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGARET MARIE IVERS LPC

Provider Business Mailing Address
First Line	:	818 WEST ST
Second Line	:	SUITE 814
City	:	WATERTOWN
State	:	WI
Zip	:	53094-3608
Country	:	US
Telephone Number	:	920-306-2174
Fax Number	:

Provider Business Practice Location Address
First Line	:	818 WEST ST
Second Line	:	SUITE 814
City	:	WATERTOWN
State	:	WI
Zip	:	53094-3608
Country	:	US
Telephone Number	:	920-306-2174
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2022
Last Update Date	:	03/07/2024

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Directions to “ MARGARET MARIE IVERS LPC” Practice Location

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