Provider Demographics
NPI:1407868672
Name:FEARON, SHARON ELLEN (BS/BCC/LADC)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:ELLEN
Last Name:FEARON
Suffix:
Gender:F
Credentials:BS/BCC/LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14005 ARGON ST NW
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:MN
Mailing Address - Zip Code:55303-2293
Mailing Address - Country:US
Mailing Address - Phone:763-433-9032
Mailing Address - Fax:
Practice Address - Street 1:7590 LYRIC LN NE
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-3251
Practice Address - Country:US
Practice Address - Phone:763-236-4300
Practice Address - Fax:763-236-4370
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN301877101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)