Healthcare Provider Details

I. General information

NPI: 1962513713
Provider Name (Legal Business Name): SHARON MASON M.A. L.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 01/19/2022
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 FAIRVIEW AVE N STE 100
ROSEVILLE MN
55113-1306
US

IV. Provider business mailing address

2720 FAIRVIEW AVE N STE 100
ROSEVILLE MN
55113-1306
US

V. Phone/Fax

Practice location:
  • Phone: 651-241-5290
  • Fax: 651-241-5140
Mailing address:
  • Phone: 651-241-5290
  • Fax: 651-241-5140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP3070
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: