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NPI Code Detail

MEDICARE: JULIE IVERSON

MEDICARE: JULIE IVERSON
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
1101Y00000XCounselorCC02411MN

General Provider Information

NPI Number : 1730562919
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULIE IVERSON
Provider Business Mailing Address
First Line : 19877 JACKSON ST NE
Second Line :
City : EAST BETHEL
State : MN
Zip : 55011-9580
Country : US
Telephone Number : 612-636-6127
Fax Number :
Provider Business Practice Location Address
First Line : 11660 ROUND LAKE BLVD NW
Second Line :
City : COON RAPIDS
State : MN
Zip : 55433-2638
Country : US
Telephone Number : 763-767-3350
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2015
Last Update Date : 03/27/2020

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Directions to “ JULIE IVERSON ” Practice Location

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