MEDICARE: RHONDA B NIETFELD-SUNDERMANN MSW, LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	13852	MN

General Provider Information

NPI Number	:	1952541443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RHONDA B NIETFELD-SUNDERMANN MSW, LICSW

Provider Business Mailing Address
First Line	:	PO BOX 10
Second Line	:
City	:	STARBUCK
State	:	MN
Zip	:	56381-0010
Country	:	US
Telephone Number	:	320-239-2257
Fax Number	:	320-239-1420

Provider Business Practice Location Address
First Line	:	500 JOHN ST
Second Line	:
City	:	STARBUCK
State	:	MN
Zip	:	56381-4623
Country	:	US
Telephone Number	:	320-239-2257
Fax Number	:	320-239-1420

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2009
Last Update Date	:	02/24/2009

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