1588724801 NPI number — SHERYL J. FREEMAN, LTD.

Table of content: (NPI 1588724801)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588724801 NPI number — SHERYL J. FREEMAN, LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHERYL J. FREEMAN, LTD.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588724801
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15017 ORCHARD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURNSVILLE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55306-4939
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-435-5782
Provider Business Mailing Address Fax Number:
952-435-5782

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14581 GRAND AVE STE 204
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURNSVILLE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55306-5733
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-435-5782
Provider Business Practice Location Address Fax Number:
952-435-5782
Provider Enumeration Date:
12/08/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FREEMAN
Authorized Official First Name:
SHERYL
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
952-435-5782

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  1109 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 351R0FR . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 244794 . This is a "COMPSYCH" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".