Provider Demographics
NPI:1124090642
Name:GUNDERSON, BEVERLY J (EDD)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:J
Last Name:GUNDERSON
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 86370
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57118-6370
Mailing Address - Country:US
Mailing Address - Phone:605-322-7510
Mailing Address - Fax:605-322-6475
Practice Address - Street 1:4400 W 69TH ST
Practice Address - Street 2:STE 1500
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-8170
Practice Address - Country:US
Practice Address - Phone:605-322-5700
Practice Address - Fax:605-322-5704
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SD195103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD680015878OtherRR MEDICARE
SDP195OtherDAKOTACARE
ND12200Medicaid
SD412991028090OtherPREFERRED ONE
MN581816800Medicaid
SD596332OtherARAZ/ AMERICA'S PPO
MN040121002OtherPRIMEWEST
SD10635OtherMIDLANDS CHOICE
SD57108C025OtherWPS TRICARE
NE46022474352Medicaid
SD0040485OtherBLUE CROSS
MN141M3GUOtherCC SYSTEMS/ BLUE PLUS
IA3989442Medicaid
MN122288OtherUCARE
SD28142OtherSANFORD HEALTH PLAN
SDHP24855OtherHEALTPARTNERS
SD6550806Medicaid
MN141M3GUOtherCC SYSTEMS/ BLUE PLUS
NE46022474352Medicaid