Individual
SANDRA MARIE IVERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
4624 154TH AVE NW, WILLISTON, ND 58801
(701) 651-6352
Mailing address
4624 154TH AVE NW, WILLISTON, ND 58801-8692
(701) 651-6352
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
4265
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
54516
—
ND
Enumeration date
09/19/2008
Last updated
10/20/2017
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