Healthcare Provider Details

I. General information

NPI: 1376201632
Provider Name (Legal Business Name): ELIZABETH K. SUNDBLAD BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2021
Last Update Date: 03/28/2026
Certification Date: 03/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 ASH ST
ISHPEMING MI
49849-1017
US

IV. Provider business mailing address

1700 ASH ST
ISHPEMING MI
49849-1017
US

V. Phone/Fax

Practice location:
  • Phone: 906-262-0071
  • Fax:
Mailing address:
  • Phone: 906-262-0071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number24191040701
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: