Healthcare Provider Details

I. General information

NPI: 1245604743
Provider Name (Legal Business Name): LANEY ZUNDEL-STENQUIST LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2015
Last Update Date: 05/24/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8530 KENTFORD DR
SPRINGFIELD VA
22152-3243
US

IV. Provider business mailing address

8530 KENTFORD DR
SPRINGFIELD VA
22152-3243
US

V. Phone/Fax

Practice location:
  • Phone: 801-783-9604
  • Fax:
Mailing address:
  • Phone: 801-783-9604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904011179
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: