Provider Demographics
NPI:1407150808
Name:RUNDELL, ROBIN L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:L
Last Name:RUNDELL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 NORTH MICHIGAN AVENUE
Mailing Address - Street 2:SUITE 2016
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601
Mailing Address - Country:US
Mailing Address - Phone:312-915-0056
Mailing Address - Fax:
Practice Address - Street 1:307 NORTH MICHIGAN AVENUE
Practice Address - Street 2:SUITE 2016
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601
Practice Address - Country:US
Practice Address - Phone:312-915-0056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.004420103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical