Healthcare Provider Details

I. General information

NPI: 1427350362
Provider Name (Legal Business Name): CHERYL KAY SYBESMA VAN NOORD PH.D., LP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHERYL SYBESMA PH.D., LP

II. Dates (important events)

Enumeration Date: 11/29/2010
Last Update Date: 02/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8009 34TH AVE S RIVERVIEW OFFICE TOWER, SUITE 1490
BLOOMINGTON MN
55425-1608
US

IV. Provider business mailing address

8009 34TH AVE S RIVERVIEW OFFICE TOWER, SUITE 1490
BLOOMINGTON MN
55425-1608
US

V. Phone/Fax

Practice location:
  • Phone: 612-408-5857
  • Fax:
Mailing address:
  • Phone: 612-408-5857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number5285
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number5285
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: