Provider Demographics
NPI:1881800167
Name:IVERSON, JANICE LANAY (LPC)
Entity type:Individual
Prefix:MS
First Name:JANICE
Middle Name:LANAY
Last Name:IVERSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 PERSHING AVE N
Mailing Address - Street 2:
Mailing Address - City:NEW PRAGUE
Mailing Address - State:MN
Mailing Address - Zip Code:56071-2163
Mailing Address - Country:US
Mailing Address - Phone:952-224-6871
Mailing Address - Fax:
Practice Address - Street 1:8500 210TH ST W
Practice Address - Street 2:140 I
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-5707
Practice Address - Country:US
Practice Address - Phone:952-224-6871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00377101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health