Provider Demographics
NPI:1205360989
Name:SUNDLY, MARCIE
Entity Type:Individual
Prefix:
First Name:MARCIE
Middle Name:
Last Name:SUNDLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARCIE
Other - Middle Name:
Other - Last Name:SUNDLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1100 N TOM WATSON PL
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99623-4160
Mailing Address - Country:US
Mailing Address - Phone:907-715-8202
Mailing Address - Fax:
Practice Address - Street 1:1100 N TOM WATSON PL
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99623-4160
Practice Address - Country:US
Practice Address - Phone:907-715-8202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-19
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician