Provider Demographics
NPI:1942395256
Name:DOFFING, SHARON KAY (MSLP)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:KAY
Last Name:DOFFING
Suffix:
Gender:F
Credentials:MSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3350 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-5373
Mailing Address - Country:US
Mailing Address - Phone:651-770-4995
Mailing Address - Fax:
Practice Address - Street 1:4505 WHITE BEAR PKWY
Practice Address - Street 2:#1800
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-3678
Practice Address - Country:US
Practice Address - Phone:651-426-8191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 0486103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist