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Contact Information

LEISEL IVERSON, ATC
1641 N. MILKWAUKEE AVENUE
ADLER PARK PLAZA, SUITE 7
LIBERTYVILLE, IL60048
 Phone: 847-362-6919
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Psychologist

103T00000X 62 Psychologist, Clinical
 

Athletic Trainer

2255A2300X
Indicates primary specialty

NPI Profile & details for LEISEL IVERSON · (Female)

NPI # 1295486769
Status Active
Credentials ATC
Entity Individual
Enumeration date 01/15/2022
Last updated 01/15/2022 - About 4 years ago
Sole proprietor 1 Yes
Identifiers
  • License # 080502241
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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