Provider Demographics
NPI:1295038719
Name:GUNDERSON, PATRICK (PHD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:
Last Name:GUNDERSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 E ALGONQUIN RD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4188
Mailing Address - Country:US
Mailing Address - Phone:847-778-7365
Mailing Address - Fax:
Practice Address - Street 1:2030 E ALGONQUIN RD
Practice Address - Street 2:SUITE 401
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4188
Practice Address - Country:US
Practice Address - Phone:847-778-7365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-06
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008621103TC0700X, 103TF0000X, 103TB0200X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral