Heather Ann Ivy, SUDP III

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

CP61678744 Issued in WA

Practice address

1415 Center St
Tacoma, WA 98409-8210

Phone

(253) 280-9860

Fax

(253) 280-9870

NPI assigned

Mar 2, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Heather Ann Sample Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Sea Mar Community Health Centers

  • Federally Qualified Health Center (FQHC)
  • Tacoma, WA
  • NPI 1235287855
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1677715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751932800000",
    "number": "1225738859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9650 15TH AVE SW",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981062576",
            "telephone_number": "206-965-1055",
            "fax_number": "206-965-1032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 CENTER ST",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984098210",
            "telephone_number": "253-280-9860",
            "fax_number": "253-280-9870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IVY",
        "first_name": "HEATHER",
        "middle_name": "ANN",
        "credential": "SUDP III",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-02",
        "last_updated": "2025-07-08",
        "certification_date": "2025-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CP61678744",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "WA",
            "license": "CO61296221",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HEATHER",
            "last_name": "SAMPLE",
            "middle_name": "ANN",
            "credential": "SUDP-T",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Amanda Jane Iverson, LMT 70006694
• Andrew Iverson, N.D.
• Samantha Iverson
• Sarah Iverson
• Madigan Ivie
• Chukwuemeka B Iwuagwu
• Jaisimha K Iyengar, MD
• Meera Iyer, M.D
• Norelle Iyer, L.M.P
• Raj Iyer, MD

• Addiction (Substance Use Disorder) Counselor in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Addiction (Substance Use Disorder) Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.