Provider Demographics
NPI:1043763691
Name:SUNDEEN, JOAN
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:SUNDEEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:564 HIGHWAY 133
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:CO
Mailing Address - Zip Code:81623-1645
Mailing Address - Country:US
Mailing Address - Phone:970-963-2700
Mailing Address - Fax:970-963-2702
Practice Address - Street 1:564 HIGHWAY 133
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:CO
Practice Address - Zip Code:81623-1645
Practice Address - Country:US
Practice Address - Phone:970-963-2700
Practice Address - Fax:970-963-2702
Is Sole Proprietor?:No
Enumeration Date:2016-08-01
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0019152225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist