Provider Demographics
NPI:1942941950
Name:SUNDHEIM, AMY (MED, CAGS, BCBA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:SUNDHEIM
Suffix:
Gender:F
Credentials:MED, CAGS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 MISSION RD
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-9361
Mailing Address - Country:US
Mailing Address - Phone:206-707-5683
Mailing Address - Fax:
Practice Address - Street 1:601 E PIONEER AVE STE 209
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7694
Practice Address - Country:US
Practice Address - Phone:907-435-1071
Practice Address - Fax:907-531-7360
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK192847103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty