Provider Demographics
NPI:1659403350
Name:SUNDBLAD, DEBRA CLARE (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:CLARE
Last Name:SUNDBLAD
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 SHERMER RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-4500
Mailing Address - Country:US
Mailing Address - Phone:847-480-8709
Mailing Address - Fax:847-480-1348
Practice Address - Street 1:1200 SHERMER RD
Practice Address - Street 2:SUITE 208
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4500
Practice Address - Country:US
Practice Address - Phone:847-480-8709
Practice Address - Fax:847-480-1348
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical