Provider Demographics
NPI:1477881779
Name:THORESEN, CHERYL (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:
Last Name:THORESEN
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8900 PENN AVE S
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-2068
Mailing Address - Country:US
Mailing Address - Phone:952-224-9558
Mailing Address - Fax:952-224-9881
Practice Address - Street 1:8900 PENN AVE S
Practice Address - Street 2:SUITE 301
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-2068
Practice Address - Country:US
Practice Address - Phone:952-224-9558
Practice Address - Fax:952-224-9881
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-24
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 5189103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist