Active NPI
Mary Donna Iverson
- Speech-Language Pathologist
- Mokena, IL
National Provider Identifier
1427192996
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- Practice address
- 19065 Hickory Creek PL Ste 110
Mokena, IL 60448-8597 - Phone
- (708) 478-5400
- Fax
- (708) 478-5300
- NPI assigned
- Feb 17, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | IL | Primary |
Addresses
Primary practice location
19065 Hickory Creek PL Ste 110
Mokena, IL 60448-8597
Mailing address
390 E Nebraska St
Frankfort, IL 60423-1578
Phone (815) 464-5855
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 146002495 | IL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171670400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1427192996",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "390 E NEBRASKA ST",
"city": "FRANKFORT",
"state": "IL",
"postal_code": "604231578",
"telephone_number": "815-464-5855"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19065 HICKORY CREEK PL STE 110",
"city": "MOKENA",
"state": "IL",
"postal_code": "604488597",
"telephone_number": "708-478-5400",
"fax_number": "708-478-5300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IVERSON",
"first_name": "MARY",
"middle_name": "DONNA",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mokena, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.