Provider Demographics
NPI:1003081779
Name:SUNDEEN, JOSEPH P
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:P
Last Name:SUNDEEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1935 COUNTY ROAD B2 W STE 160
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-2782
Mailing Address - Country:US
Mailing Address - Phone:651-330-0144
Mailing Address - Fax:651-330-0575
Practice Address - Street 1:1935 COUNTY ROAD B2 W STE 160
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-2782
Practice Address - Country:US
Practice Address - Phone:651-330-0144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5226103TC1900X
MNLPP 0124101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health