Provider Demographics
NPI:1669939732
Name:SUNDE, RUTH ANN (LICSW)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:ANN
Last Name:SUNDE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:RUTH
Other - Middle Name:ANN
Other - Last Name:NIEMEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:92D MEDICAL GROUP/SGOW
Mailing Address - Street 2:701 HOSPITAL LOOP, SUITE 259
Mailing Address - City:FAIRCHILD AFB
Mailing Address - State:WA
Mailing Address - Zip Code:99011
Mailing Address - Country:US
Mailing Address - Phone:509-247-5409
Mailing Address - Fax:
Practice Address - Street 1:92D MEDICAL GROUP/SGOW
Practice Address - Street 2:701 HOSPITAL LOOP, SUITE 259
Practice Address - City:FAIRCHILD AFB
Practice Address - State:WA
Practice Address - Zip Code:99011
Practice Address - Country:US
Practice Address - Phone:509-247-5409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW607764281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical