Individual
VANESSA IVERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC-MH
Contact information
Practice address
111 WASHINGTON AVE NW, WAGNER, SD 57380-4300
(605) 384-3621
Mailing address
111 WASHINGTON AVE NW, WAGNER, SD 57380-4300
(605) 384-3621
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC-MH30619
SD
101YP2500X
Professional Counselor
LPC20379
SD
Other
Enumeration date
12/17/2018
Last updated
10/21/2021
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