Healthcare Provider Details

I. General information

NPI: 1073990800
Provider Name (Legal Business Name): CHERYL TREDWAY LPCC, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2015
Last Update Date: 08/16/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3674 S WASHINGTON ST
GRAND FORKS ND
58201-5766
US

IV. Provider business mailing address

3674 S WASHINGTON ST
GRAND FORKS ND
58201-5766
US

V. Phone/Fax

Practice location:
  • Phone: 701-205-3000
  • Fax: 701-732-2501
Mailing address:
  • Phone: 701-205-3000
  • Fax: 701-732-2501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3673
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number605
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2381
License Number StateKS
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2640
License Number StateKS
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1257-12-15-22-508
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: