Provider Demographics
NPI:1184848939
Name:WARD, SHARON ANNE (MA)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:ANNE
Last Name:WARD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 E CONNECTICUT ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CROIX FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54024-9117
Mailing Address - Country:US
Mailing Address - Phone:952-491-4490
Mailing Address - Fax:
Practice Address - Street 1:220 E CONNECTICUT ST
Practice Address - Street 2:
Practice Address - City:SAINT CROIX FALLS
Practice Address - State:WI
Practice Address - Zip Code:54024-9117
Practice Address - Country:US
Practice Address - Phone:952-491-4490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3698103TC0700X
WI5162-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN204219300Medicaid