Healthcare Provider Details

I. General information

NPI: 1023691896
Provider Name (Legal Business Name): SHARI PHILLIPS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 ASH AVE NW SUITE 2
WADENA MN
56482-1347
US

IV. Provider business mailing address

310 3RD ST NW
WADENA MN
56482-1118
US

V. Phone/Fax

Practice location:
  • Phone: 218-640-7368
  • Fax:
Mailing address:
  • Phone: 218-640-7368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHARI LYNN PHILLIPS
Title or Position: OWNER/COUNSELOR
Credential: LPCC
Phone: 218-640-7368