Sherie Lynn Carlson, PHD, LP

Primary specialty

PsychologistTaxonomy code 103T00000X

License

LP3982 Issued in MN

Practice address

324 Broadway St
Ste 206
Alexandria, MN 56308-1482

Phone

(320) 762-1762

Fax

(320) 762-0796

NPI assigned

Nov 6, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Sherie Carlson PHD LP PLLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Alexandria, MN
  • NPI 1285159582
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477353600000",
    "number": "1366511354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24599 165TH ST",
            "city": "GLENWOOD",
            "state": "MN",
            "postal_code": "56334",
            "telephone_number": "320-491-7783",
            "fax_number": "320-762-0796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "324 BROADWAY ST",
            "address_2": "STE 206",
            "city": "ALEXANDRIA",
            "state": "MN",
            "postal_code": "563081482",
            "telephone_number": "320-762-1762",
            "fax_number": "320-762-0796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLSON",
        "first_name": "SHERIE",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "PHD, LP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-06",
        "last_updated": "2016-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP3982",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "936488900",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BHP",
            "identifier": "136937",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "218G2MA",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRIMEWEST HEALTH SYSTEMS",
            "identifier": "936488900",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UBH",
            "identifier": "6267225",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rita Marie Cannonwolf, B.A, T-ADC
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• Brian D Carlsen, MD
• Christine Carlson
• Kent Arthur Carlson, MD
• Mary Louise Vano Carpenter
• Heidi Carstensen
• Julissa Celisvictoria
• Center for Pain Management Ambulatory Surgery, LTD
• Centracare Medical Supply LLC (Rice Home Medical LLC - DME Alexandria)

• Psychologist in Alexandria, MN
• Providers in Alexandria, MN by specialty
• Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.