Provider Demographics
NPI:1306473814
Name:SUNDEEN, JOHN DAVID (MA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVID
Last Name:SUNDEEN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3734 HILLSIDE RD
Mailing Address - Street 2:
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901-5517
Mailing Address - Country:US
Mailing Address - Phone:907-821-4674
Mailing Address - Fax:
Practice Address - Street 1:3734 HILLSIDE RD
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-5517
Practice Address - Country:US
Practice Address - Phone:907-821-4674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-25
Last Update Date:2025-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC18904101YM0800X
AK156870101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health