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General NPI Number Information
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NPI Number | 1497812622
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Entity Type | Organization
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Legal Business Name | SHARON GROSTEPHAN, LICSW
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 04/29/2019
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Provider Practice Location Address
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Address Line | 1660 S HIGHWAY 100 SUITE 428
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City | ST LOUIS PARK
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State | MN
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Zip | 55416-1533
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Country | US
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Telephone | 612-597-6585
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Fax |
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Provider Business Mailing Address
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Address Line | 1660 S HIGHWAY 100 SUITE 428
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City | ST LOUIS PARK
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State | MN
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Zip | 55416-1533
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Country | US
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Telephone | 612-597-6585
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Fax |
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Authorized Official
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Title or Position | LICENSED SOCIAL WORKER
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Name | MS. SHARON GROSTEPHAN
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Credential | LICSW
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Telephone | 763-441-9712
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LICSW 841
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License Number State | MN
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