Healthcare Provider Details

I. General information

NPI: 1629188263
Provider Name (Legal Business Name): MICHELLE DEANNE SHERMAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 05/04/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1772 STIEGER LAKE LN STE 220
VICTORIA MN
55386-7723
US

IV. Provider business mailing address

PO BOX 51
VICTORIA MN
55386-0051
US

V. Phone/Fax

Practice location:
  • Phone: 952-443-4600
  • Fax: 952-443-4604
Mailing address:
  • Phone: 952-443-4600
  • Fax: 952-443-4604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP5985
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number824
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP5985
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: