Provider Demographics
NPI:1689772998
Name:SHEARER, SANDRA LEE (MSW, LP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LEE
Last Name:SHEARER
Suffix:
Gender:F
Credentials:MSW, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:748 ROSELAWN AVE E
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55117-2244
Mailing Address - Country:US
Mailing Address - Phone:651-747-7862
Mailing Address - Fax:763-571-4231
Practice Address - Street 1:7362 UNIVERSITY AVE NE
Practice Address - Street 2:SUITE 209
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-3142
Practice Address - Country:US
Practice Address - Phone:651-747-7862
Practice Address - Fax:763-571-4231
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2425103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN287748100Medicaid