Provider Demographics
NPI:1396967865
Name:SUNDEEN, BAIRD WAYNE (LSW)
Entity type:Individual
Prefix:MR
First Name:BAIRD
Middle Name:WAYNE
Last Name:SUNDEEN
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 COLLEGE DR N
Mailing Address - Street 2:
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-1550
Mailing Address - Country:US
Mailing Address - Phone:701-662-8393
Mailing Address - Fax:701-775-7880
Practice Address - Street 1:1601 COLLEGE DR N
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-1550
Practice Address - Country:US
Practice Address - Phone:701-662-8393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2081104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND456001342OtherDAY TREATMENT PROGRAM