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General NPI Number Information
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NPI Number | 1992316608
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Entity Type | Individual
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Provider Name | MELISSA SUNDBERG LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/14/2020
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Last Update Date | 07/25/2024
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Provider Practice Location Address
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Address Line | 3 SAINT ELIZABETH BLVD STE 4000
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City | O FALLON
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State | IL
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Zip | 62269-1284
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Country | US
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Telephone | 618-233-5480
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Fax | 618-222-4792
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Provider Business Mailing Address
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Address Line | 3 SAINT ELIZABETH BLVD STE 4000
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City | O FALLON
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State | IL
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Zip | 62269-1284
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Country | US
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Telephone | 618-233-5480
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Fax | 618-222-4792
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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 | 44018
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License Number State | MT
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