Provider Demographics
NPI:1407035793
Name:SUNDBERG, TANYA DAHMS (PHD , LP)
Entity Type:Individual
Prefix:DR
First Name:TANYA
Middle Name:DAHMS
Last Name:SUNDBERG
Suffix:
Gender:F
Credentials:PHD , LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-2719
Mailing Address - Country:US
Mailing Address - Phone:218-736-2606
Mailing Address - Fax:
Practice Address - Street 1:123 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-2216
Practice Address - Country:US
Practice Address - Phone:218-998-3123
Practice Address - Fax:218-998-3126
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 4873103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist