Healthcare Provider Details

I. General information

NPI: 1609843002
Provider Name (Legal Business Name): LAURA SUNDELL LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1570 42ND STREET NE, STE. 8
CEDAR RAPIDS IA
52402
US

IV. Provider business mailing address

1570 42ND STREET NE, STE. 8
CEDAR RAPIDS IA
52402
US

V. Phone/Fax

Practice location:
  • Phone: 319-294-6090
  • Fax:
Mailing address:
  • Phone: 319-573-8095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number05984
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: