Provider Demographics
NPI:1700908951
Name:KUNDEL, SUSAN M (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:KUNDEL
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 PRIOR AVE N STE 202
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-5165
Mailing Address - Country:US
Mailing Address - Phone:651-788-2913
Mailing Address - Fax:
Practice Address - Street 1:366 PRIOR AVE N STE 202
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-5165
Practice Address - Country:US
Practice Address - Phone:651-788-2913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4451104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker