Healthcare Provider Details

I. General information

NPI: 1215891650
Provider Name (Legal Business Name): SHERRI EIDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7580 160TH ST W
LAKEVILLE MN
55044-8348
US

IV. Provider business mailing address

16985 FESTAL AVE
FARMINGTON MN
55024-7825
US

V. Phone/Fax

Practice location:
  • Phone: 952-898-1133
  • Fax:
Mailing address:
  • Phone: 952-913-6099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: