MEDICARE: DR. MICHELLE DEANNE SHERMAN PHD

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	103T00000X	Psychologist	LP5985	MN
2	103TF0000X	Family Psychologist	824	OK
3	103TC0700X	Clinical Psychologist	LP5985	MN

General Provider Information

NPI Number	:	1629188263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE DEANNE SHERMAN PHD

Provider Business Mailing Address
First Line	:	PO BOX 51
Second Line	:
City	:	VICTORIA
State	:	MN
Zip	:	55386-0051
Country	:	US
Telephone Number	:	952-443-4600
Fax Number	:	952-443-4604

Provider Business Practice Location Address
First Line	:	1772 STIEGER LAKE LN STE 220
Second Line	:
City	:	VICTORIA
State	:	MN
Zip	:	55386-7723
Country	:	US
Telephone Number	:	952-443-4600
Fax Number	:	952-443-4604

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	05/04/2021

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