Nicole Marie Iverson, M.A.

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

1224-124 Issued in WI

Practice address

2004 Highland Ave Ste M
Eau Claire, WI 54701-4389

Phone

(715) 355-9158

Fax

(715) 835-8112

NPI assigned

May 8, 2015

Last updated

Jan 7, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Children's Service Society of Wisconsin

  • Community/Behavioral Health Agency
  • Eau Claire, WI
  • NPI 1184896920
  NPD

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

{
    "created_epoch": "1431043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578355200000",
    "number": "1801274931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9000 W WISCONSIN AVE # MS 958",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532264874",
            "telephone_number": "414-266-7615",
            "fax_number": "414-266-6238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2004 HIGHLAND AVE STE M",
            "city": "EAU CLAIRE",
            "state": "WI",
            "postal_code": "547014389",
            "telephone_number": "715-355-9158",
            "fax_number": "715-835-8112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IVERSON",
        "first_name": "NICOLE",
        "middle_name": "MARIE",
        "credential": "M.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-05-08",
        "last_updated": "2020-01-07",
        "certification_date": "2020-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "WI",
            "license": "1224-124",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1801274931",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Interweave Therapy
• Rene Lamoureux Ippolite
• Matthew J. Irwin, M.D.
• Stephanie Isham
• Thomas Andrew Israel, MD
• Andrea Ives, LMT
• James S. Iwakiri, MD
• Renee M Jablonske
• Raed Jabr
• Rachel R Jack, DNP

• Marriage & Family Therapist in Eau Claire, WI
• Providers in Eau Claire, WI by specialty
• Marriage & Family Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2020; 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.