Provider Demographics
NPI:1033144415
Name:SUNDEM, ROMY PAIGE (MA LMFT)
Entity Type:Individual
Prefix:MS
First Name:ROMY
Middle Name:PAIGE
Last Name:SUNDEM
Suffix:
Gender:F
Credentials:MA LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2809 WAYZATA BLVD
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55405-2125
Mailing Address - Country:US
Mailing Address - Phone:612-377-9190
Mailing Address - Fax:612-374-4498
Practice Address - Street 1:2809 WAYZATA BLVD
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55405-2125
Practice Address - Country:US
Practice Address - Phone:612-377-9190
Practice Address - Fax:612-374-4498
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN933106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
116042OtherOPTUM
HP28452OtherHEALTH PARTNERS
922241025754OtherPREFERRRED ONE
126139C851OtherUCARE
6267255OtherMEDICA
99D37SUOtherBCBS
MN168018800Medicaid
MN168018800Medicaid