Provider Demographics
NPI:1023780277
Name:SAUNDRA L. MORTENSON, LMSW, LCSW, PLLC
Entity type:Organization
Organization Name:SAUNDRA L. MORTENSON, LMSW, LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAUNDRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MORTENSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW LCSW
Authorized Official - Phone:219-861-6156
Mailing Address - Street 1:3130 S 11TH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-4736
Mailing Address - Country:US
Mailing Address - Phone:219-861-6156
Mailing Address - Fax:
Practice Address - Street 1:3130 S 11TH ST STE 103
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-4736
Practice Address - Country:US
Practice Address - Phone:219-861-6156
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-05
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty