Provider Demographics
NPI:1255435384
Name:SUNDELL, SUSAN E (PHD,LP)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:E
Last Name:SUNDELL
Suffix:
Gender:F
Credentials:PHD,LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14660 LAKE STREET EXT
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345
Mailing Address - Country:US
Mailing Address - Phone:612-272-0800
Mailing Address - Fax:952-935-7303
Practice Address - Street 1:11900 WAYZATA BLVD
Practice Address - Street 2:SUITE 112
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305
Practice Address - Country:US
Practice Address - Phone:612-272-0800
Practice Address - Fax:952-935-7303
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2763103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical