Kourtnie J. Michelle Iverson, LSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

I.2102873 Issued in OH

Practice address

60 N Stygler Rd
Gahanna, OH 43230-2435

Phone

(614) 475-2014

NPI assigned

Sep 16, 2016

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 identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1473984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649635200000",
    "number": "1982152146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1791 ALUM CREEK DR",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432071708",
            "telephone_number": "614-445-8131",
            "fax_number": "614-827-8380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 N STYGLER RD",
            "city": "GAHANNA",
            "state": "OH",
            "postal_code": "432302435",
            "telephone_number": "614-475-2014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IVERSON",
        "first_name": "KOURTNIE",
        "middle_name": "J. MICHELLE",
        "credential": "LSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-16",
        "last_updated": "2022-04-11",
        "certification_date": "2022-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "S1500695",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I.2102873",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0283825",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Gahanna, OH
• Providers in Gahanna, OH by specialty
• Clinical Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2022; 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.