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NPI Code Detail

MEDICARE: MRS. SHERIE LYNN CARLSON PHD, LP

MEDICARE: MRS. SHERIE LYNN CARLSON PHD, LP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologistLP3982MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2136937OTHERBHP
3218G2MAOTHERMNBLUE CROSS BLUE SHIELD
4936488900OTHERMNPRIMEWEST HEALTH SYSTEMS
56267225OTHERUBH

General Provider Information

NPI Number : 1366511354
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SHERIE LYNN CARLSON PHD, LP
Provider Business Mailing Address
First Line : 24599 165TH ST
Second Line :
City : GLENWOOD
State : MN
Zip : 56334
Country : US
Telephone Number : 320-491-7783
Fax Number : 320-762-0796
Provider Business Practice Location Address
First Line : 324 BROADWAY ST
Second Line : STE 206
City : ALEXANDRIA
State : MN
Zip : 56308-1482
Country : US
Telephone Number : 320-762-1762
Fax Number : 320-762-0796
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/06/2006
Last Update Date : 10/25/2016

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