MEDICARE: MS. 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	841	MN

General Provider Information

NPI Number	:	1548243181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHARON GROSTEPHAN LICSW

Provider Business Mailing Address
First Line	:	1660 HIGHWAY 100 S
Second Line	:	SUITE 428
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-1529
Country	:	US
Telephone Number	:	763-441-9712
Fax Number	:

Provider Business Practice Location Address
First Line	:	1660 HIGHWAY 100 S
Second Line	:	SUITE 428
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-1529
Country	:	US
Telephone Number	:	763-441-9712
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	07/08/2007

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