Provider Demographics
NPI:1124296876
Name:SUNDFOR, ANNETTE E (PSYD)
Entity type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:E
Last Name:SUNDFOR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:ANNETTE
Other - Middle Name:E
Other - Last Name:TERRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:106 W PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:ELBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60119-8201
Mailing Address - Country:US
Mailing Address - Phone:309-716-0869
Mailing Address - Fax:
Practice Address - Street 1:106 W PIERCE ST
Practice Address - Street 2:
Practice Address - City:ELBURN
Practice Address - State:IL
Practice Address - Zip Code:60119-8201
Practice Address - Country:US
Practice Address - Phone:309-716-0869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-15
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL210835Medicare PIN