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General NPI Number Information
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NPI Number | 1144236118
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Entity Type | Individual
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Provider Name | JEFFREY BYRON SUNDBERG LCSW
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Gender | Male
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 610 E STATE ST A
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City | ROCKFORD
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State | IL
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Zip | 61104-1038
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Country | US
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Telephone | 815-332-8342
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Fax | 815-332-8342
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Provider Business Mailing Address
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Address Line | 610 A EAST STATE STREET
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City | ROCKFORD
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State | IL
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Zip | 61110-7044
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Country | US
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Telephone | 815-332-8342
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Fax | 815-332-8342
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State | IL
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