Provider Demographics
NPI:1922342666
Name:COMO, CHERYL (LICSW)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:
Last Name:COMO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9168 JAREAU AVE S
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-4059
Mailing Address - Country:US
Mailing Address - Phone:651-428-6221
Mailing Address - Fax:
Practice Address - Street 1:2800 UNIVERSITY AVE SE
Practice Address - Street 2:SUITE 204
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-3232
Practice Address - Country:US
Practice Address - Phone:612-816-6990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN84451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical