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General NPI Number Information
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NPI Number | 1477881779
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Entity Type | Individual
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Provider Name | CHERYL THORESEN PH.D., LP
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Gender | Female
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Dates
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Enumeration Date | 11/24/2009
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Last Update Date | 03/18/2010
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Provider Practice Location Address
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Address Line | 8900 PENN AVE S SUITE 301
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City | BLOOMINGTON
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State | MN
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Zip | 55431-2068
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Country | US
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Telephone | 952-224-9558
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Fax | 952-224-9881
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Provider Business Mailing Address
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Address Line | 8900 PENN AVE S SUITE 301
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City | BLOOMINGTON
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State | MN
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Zip | 55431-2068
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Country | US
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Telephone | 952-224-9558
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Fax | 952-224-9881
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | LP 5189
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License Number State | MN
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