Provider Demographics
NPI:1932345758
Name:SUNDEEN, KIRSTEN (LCSW-C)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:SUNDEEN
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 256
Mailing Address - Street 2:
Mailing Address - City:KOTZEBUE
Mailing Address - State:AK
Mailing Address - Zip Code:99752-0256
Mailing Address - Country:US
Mailing Address - Phone:907-442-7640
Mailing Address - Fax:
Practice Address - Street 1:733 2ND AVENUE
Practice Address - Street 2:
Practice Address - City:KOTZEBUE
Practice Address - State:AK
Practice Address - Zip Code:99754
Practice Address - Country:US
Practice Address - Phone:907-442-7640
Practice Address - Fax:907-442-7749
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-29
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MD130601041C0700X
AK11572411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health