Provider Demographics
NPI:1831324557
Name:SUNDSMO, ALECIA (PSYD)
Entity Type:Individual
Prefix:
First Name:ALECIA
Middle Name:
Last Name:SUNDSMO
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 1:200 4TH AVE W
Mailing Address - Street 2:
Mailing Address - City:GRINNELL
Mailing Address - State:IA
Mailing Address - Zip Code:50112-1833
Mailing Address - Country:US
Mailing Address - Phone:641-236-6137
Mailing Address - Fax:641-236-0206
Practice Address - Street 1:200 4TH AVE W
Practice Address - Street 2:
Practice Address - City:GRINNELL
Practice Address - State:IA
Practice Address - Zip Code:50112-1833
Practice Address - Country:US
Practice Address - Phone:641-236-6137
Practice Address - Fax:641-236-0206
Is Sole Proprietor?:No
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0069468Medicaid
IA06946OtherWELLMARK BCBS OF IOWA