Provider Demographics
NPI:1750684940
Name:IVERSON, SARA NICOLE (MA CADC LMHC)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:NICOLE
Last Name:IVERSON
Suffix:
Gender:F
Credentials:MA CADC LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 CHERRY CT
Mailing Address - Street 2:#2
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-9008
Mailing Address - Country:US
Mailing Address - Phone:319-594-4564
Mailing Address - Fax:
Practice Address - Street 1:438 SOUTHGATE AVE
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-4425
Practice Address - Country:US
Practice Address - Phone:319-351-9072
Practice Address - Fax:319-341-3930
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-10
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001288101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health