Individual
IVORY SOON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
316 2ND AVE W, WILLISTON, ND 58801-5218
(701) 774-4600
(701) 774-4620
Mailing address
316 2ND AVE W, WILLISTON, ND 58801-5218
(701) 774-4600
(701) 774-4620
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
ND
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
171M00000X
—
ND
Enumeration date
03/18/2026
Last updated
03/25/2026
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