Provider Demographics
NPI:1821631839
Name:SUNDEEN, MARNIE (LBSW)
Entity Type:Individual
Prefix:
First Name:MARNIE
Middle Name:
Last Name:SUNDEEN
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:MARNIE
Other - Middle Name:
Other - Last Name:SUNDEEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LBSW
Mailing Address - Street 1:2624 9TH AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-2350
Mailing Address - Country:US
Mailing Address - Phone:701-298-4500
Mailing Address - Fax:
Practice Address - Street 1:2624 9TH AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-2350
Practice Address - Country:US
Practice Address - Phone:701-298-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-22
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
ND5127104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator