Healthcare Provider Details

I. General information

NPI: 1073430716
Provider Name (Legal Business Name): WAYNE MICHAEL JUNDT
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E FRONT AVE STE 102
BISMARCK ND
58504-5689
US

IV. Provider business mailing address

3202 84TH AVE NE
BISMARCK ND
58503-6332
US

V. Phone/Fax

Practice location:
  • Phone: 701-975-6400
  • Fax:
Mailing address:
  • Phone: 701-975-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number63-3-8-91
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: