Provider Demographics
NPI:1891912267
Name:FRIDLUND, SHERRY L (MALP)
Entity type:Individual
Prefix:MS
First Name:SHERRY
Middle Name:L
Last Name:FRIDLUND
Suffix:
Gender:F
Credentials:MALP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1865 OLD HUDSON RD
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55119-4308
Mailing Address - Country:US
Mailing Address - Phone:651-501-2378
Mailing Address - Fax:651-738-1737
Practice Address - Street 1:7401 METRO BLVD STE 250
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-3062
Practice Address - Country:US
Practice Address - Phone:612-268-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3367103T00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN349215000OtherMHCP ID #