Healthcare Provider Details

I. General information

NPI: 1013827302
Provider Name (Legal Business Name): MINDY SUNDBECK NCSP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E GAMBLE RD
FAYETTE OH
43521-9462
US

IV. Provider business mailing address

11972 STONE BLUFF DR
GRAND LEDGE MI
48837-2436
US

V. Phone/Fax

Practice location:
  • Phone: 419-237-2776
  • Fax:
Mailing address:
  • Phone: 567-239-1687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberOH1367605
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: