Healthcare Provider Details

I. General information

NPI: 1164636668
Provider Name (Legal Business Name): RICHARD CRAIG WUNDERLICH L.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 W STARR PASS BLVD
TUCSON AZ
85713-1303
US

IV. Provider business mailing address

3515 N CAMINO DE VIS
TUCSON AZ
85745-9797
US

V. Phone/Fax

Practice location:
  • Phone: 520-225-4022
  • Fax: 520-225-4001
Mailing address:
  • Phone: 520-743-4558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLCSW - 1088
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: