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General NPI Number Information
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NPI Number | 1063230837
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Entity Type | Individual
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Provider Name | LAURA RUTHANN GUNDERSON LMSW
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Gender | Female
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Dates
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Enumeration Date | 10/01/2024
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 602 N JEFFERSON ST
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City | JUNCTION CITY
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State | KS
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Zip | 66441-2915
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Country | US
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Telephone | 785-370-3429
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Fax |
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Provider Business Mailing Address
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Address Line | 818 BLUEMONT AVE APT B
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City | MANHATTAN
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State | KS
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Zip | 66502-7958
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Country | US
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Telephone | 785-761-5931
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 13918
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License Number State | KS
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