Provider Demographics
NPI:1629742663
Name:GUNDERSON, HEATHER (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:GUNDERSON
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5715 DAKOTA RDG
Mailing Address - Street 2:
Mailing Address - City:JOHNSBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60051-8458
Mailing Address - Country:US
Mailing Address - Phone:847-989-0044
Mailing Address - Fax:
Practice Address - Street 1:5715 DAKOTA RDG
Practice Address - Street 2:
Practice Address - City:JOHNSBURG
Practice Address - State:IL
Practice Address - Zip Code:60051-8458
Practice Address - Country:US
Practice Address - Phone:847-989-0044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166.000646106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist