MEDICARE: DR. CHERYL KAY SYBESMA VAN NOORD PH.D., LP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC2200X	Clinical Child & Adolescent Psychologist	5285	MN
2	103TC0700X	Clinical Psychologist	5285	MN

General Provider Information

NPI Number	:	1427350362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHERYL KAY SYBESMA VAN NOORD PH.D., LP

Provider Business Mailing Address
First Line	:	8009 34TH AVE S
Second Line	:	RIVERVIEW OFFICE TOWER, SUITE 1490
City	:	BLOOMINGTON
State	:	MN
Zip	:	55425-1608
Country	:	US
Telephone Number	:	612-408-5857
Fax Number	:

Provider Business Practice Location Address
First Line	:	8009 34TH AVE S
Second Line	:	RIVERVIEW OFFICE TOWER, SUITE 1490
City	:	BLOOMINGTON
State	:	MN
Zip	:	55425-1608
Country	:	US
Telephone Number	:	612-408-5857
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2010
Last Update Date	:	02/01/2017

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