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General NPI Number Information
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NPI Number | 1134288962
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Entity Type | Individual
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Provider Name | SHERRY BERDE
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Gender | Female
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Dates
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Enumeration Date | 12/07/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 3570 LEXINGTON AVE N STE 100
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City | SHOREVIEW
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State | MN
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Zip | 55126-8058
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Country | US
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Telephone | 651-481-0637
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Fax |
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Provider Business Mailing Address
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Address Line | 1919 WACHTLER AVE
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City | MENDOTA HEIGHTS
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State | MN
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Zip | 55118-4333
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Country | US
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Telephone | 651-230-7514
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | LP 1429
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License Number State | MN
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