Individual provider Active NPI

Sherry L. Fridlund, MALP

  • Mental Health Counselor
  • Edina, MN
National Provider Identifier
1891912267
Registry record updated Oct 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Practice address
7401 Metro Blvd Ste 250
Edina, MN 55439-3062
Phone
(612) 268-5858
NPI assigned
Apr 19, 2007
Last updated
Oct 7, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NU Primary
Psychologist 103T00000X LP3367 MN

Addresses

Primary practice location

7401 Metro Blvd Ste 250
Edina, MN 55439-3062

Mailing address

1865 Old Hudson Rd
Saint Paul, MN 55119-4308
Phone (651) 501-2378

Other practice location 1

1314 Livingston Ave
Saint Paul, MN 55118-2409
Phone (651) 457-6999

Other identifiers 1

IdentifierTypeStateIssuer
349215000OtherMNMHCP ID #

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20240104003684 MN Practitioner - Clinical Psychologist 4385095215 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1995
Medicare assignment
May accept Medicare assignment
Group practices
Affinity Psychological Services PCGroup PAC ID 0749528552, 66 clinicians

Practice addresses (Care Compare)

3400 1St St N
Suite 101
Saint Cloud, MN 56303-1924
Phone (612) 268-5858

7401 Metro Blvd
Suite 250
Edina, MN 55439-3062
Phone (612) 268-5858

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LP3367MNMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Affinity Psychological Services, P.C. Mental Health CurrentSince Dec 22, 2023 Accepting new patients
Theodore I Past Accepting new patients

Locations

7401 Metro Blvd
Ste 250
Minneapolis, MN 55439
Phone (612) 778-8393

7401 Metro Blvd
Ste 525
Minneapolis, MN 55439

3400 1st St N
Ste 101
Saint Cloud, MN 56303
Phone (320) 202-2000

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1176940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728259200000",
    "number": "1891912267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1865 OLD HUDSON RD",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551194308",
            "telephone_number": "651-501-2378",
            "fax_number": "651-738-1737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7401 METRO BLVD STE 250",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554393062",
            "telephone_number": "612-268-5858"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1314 Livingston Ave",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "551182409",
            "country_code": "US",
            "telephone_number": "651-457-6999",
            "fax_number": "651-451-2166",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FRIDLUND",
        "first_name": "SHERRY",
        "middle_name": "L.",
        "name_prefix": "Ms.",
        "credential": "MALP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-19",
        "last_updated": "2024-10-07",
        "certification_date": "2024-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP3367",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MHCP ID #",
            "identifier": "349215000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Edina, MN

Sources for this page

Verify at the official NPI Registry.