Healthcare Provider Details

I. General information

NPI: 1346590627
Provider Name (Legal Business Name): SHEANNE SCHERBER LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2012
Last Update Date: 09/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12000 ELM CREEK BLVD N STE L70
MAPLE GROVE MN
55369-7167
US

IV. Provider business mailing address

11945 FLETCHER LN
MAPLE GROVE MN
55311-1026
US

V. Phone/Fax

Practice location:
  • Phone: 763-898-3838
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number303000
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: