Individual
SHEREEN M O'MALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LP
Contact information
Practice address
1875 STATION PARKWAYNW, ANDOVER, MN 55304-1719
(763) 482-9598
Mailing address
1875 STATION PARKWAYNW, ANDOVER, MN 55304-1719
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP 4846
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101760
UCARE
MN
01
—
483P10M
BCBS
MN
05
—
519252800
—
MN
01
—
62-02122
MEDICA
MN
01
—
990991000633
PREFERRED ONE
MN
01
—
HP18900
HEALTH PARTNERS
MN
Enumeration date
05/28/2006
Last updated
08/17/2018
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