Provider Demographics
NPI:1437643202
Name:SHERK, ALYSSE ALEXANDRA
Entity Type:Individual
Prefix:
First Name:ALYSSE
Middle Name:ALEXANDRA
Last Name:SHERK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALYSSE
Other - Middle Name:ALEXANDRA
Other - Last Name:JENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:130 NORMAN AVE S
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:MN
Mailing Address - Zip Code:56329-8767
Mailing Address - Country:US
Mailing Address - Phone:320-281-5243
Mailing Address - Fax:
Practice Address - Street 1:130 NORMAN AVE S
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:MN
Practice Address - Zip Code:56329-8767
Practice Address - Country:US
Practice Address - Phone:320-281-5243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist