Healthcare Provider Details

I. General information

NPI: 1134288962
Provider Name (Legal Business Name): SHERRY BERDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3570 LEXINGTON AVE N STE 100
SHOREVIEW MN
55126-8058
US

IV. Provider business mailing address

1919 WACHTLER AVE
MENDOTA HEIGHTS MN
55118-4333
US

V. Phone/Fax

Practice location:
  • Phone: 651-481-0637
  • Fax:
Mailing address:
  • Phone: 651-230-7514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP 1429
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: