Provider Demographics
NPI:1316914898
Name:SUNDELL, PAUL J (PHD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:SUNDELL
Suffix:
Gender:M
Credentials:PHD
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 1408
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52406-1408
Mailing Address - Country:US
Mailing Address - Phone:319-365-3993
Mailing Address - Fax:319-364-0116
Practice Address - Street 1:1730 1ST AVE NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5433
Practice Address - Country:US
Practice Address - Phone:319-365-3993
Practice Address - Fax:319-364-0116
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00905103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA39226OtherWELLMARK BC/BS
IAI15482Medicare ID - Type Unspecified