Provider Demographics
NPI:1114363959
Name:GUNNARSSON, KARL FANNAR
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:FANNAR
Last Name:GUNNARSSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 EVERGREEN TERRACE DR W
Mailing Address - Street 2:APT 1
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-3943
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2020 EVERGREEN TERRACE DR W
Practice Address - Street 2:APT. 1
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-3943
Practice Address - Country:US
Practice Address - Phone:618-203-4587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst