Healthcare Provider Details

I. General information

NPI: 1821755059
Provider Name (Legal Business Name): MUNDAHL & ANDES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2021
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 CAPITOL WAY STE B
BISMARCK ND
58501-2100
US

IV. Provider business mailing address

1616 CAPITOL WAY STE B
BISMARCK ND
58501-2100
US

V. Phone/Fax

Practice location:
  • Phone: 307-277-3619
  • Fax:
Mailing address:
  • Phone: 701-751-1145
  • Fax: 701-751-1383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: SARAH ANDES
Title or Position: CO-OWNER
Credential: LCSW
Phone: 701-751-1145