MEDICARE: SHARON GROSTEPHAN, LICSW

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
1	104100000X	Social Worker	LICSW 841	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497812622
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHARON GROSTEPHAN, LICSW

Provider Business Mailing Address
First Line	:	1660 S HIGHWAY 100
Second Line	:	SUITE 428
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-1533
Country	:	US
Telephone Number	:	612-597-6585
Fax Number	:

Provider Business Practice Location Address
First Line	:	1660 S HIGHWAY 100
Second Line	:	SUITE 428
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-1533
Country	:	US
Telephone Number	:	612-597-6585
Fax Number	:

Authorized Official
Title or Position	:	LICENSED SOCIAL WORKER
Name	:	MS. SHARON GROSTEPHAN
Credential	:	LICSW
Telephone Number	:	763-441-9712

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	04/29/2019

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