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NPI Code Detail

MEDICARE: MR. DAVID E GUNDERSON

MEDICARE: MR. DAVID E GUNDERSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist

General Provider Information

NPI Number : 1912640335
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DAVID E GUNDERSON
Provider Business Mailing Address
First Line : 409 KENYON RD STE C
Second Line :
City : FORT DODGE
State : IA
Zip : 50501-5718
Country : US
Telephone Number : 515-573-3138
Fax Number :
Provider Business Practice Location Address
First Line : 409 KENYON RD STE C
Second Line :
City : FORT DODGE
State : IA
Zip : 50501-5718
Country : US
Telephone Number : 515-573-3138
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2022
Last Update Date : 04/14/2022

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Directions to “ MR. DAVID E GUNDERSON ” Practice Location

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