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NPI Code Detail

MEDICARE: SYBIL M IVERSON CDP

MEDICARE: SYBIL M IVERSON CDP
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
1101YA0400XAddiction (Substance Use Disorder) CounselorCP00003686WA

General Provider Information

NPI Number : 1407018997
Entity Type Code : Individual
Provider Name (Legal Business Name) : SYBIL M IVERSON CDP
Provider Business Mailing Address
First Line : PO BOX 2429
Second Line :
City : LONGVIEW
State : WA
Zip : 98632-8486
Country : US
Telephone Number : 360-575-3316
Fax Number : 360-423-7813
Provider Business Practice Location Address
First Line : 1044 11TH AVE
Second Line :
City : LONGVIEW
State : WA
Zip : 98632-2506
Country : US
Telephone Number : 360-575-3316
Fax Number : 360-423-7813
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2008
Last Update Date : 09/21/2011

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