MEDICARE: MRS. STEPHANIE SUNDLING BS, CADC

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	17108	IA

General Provider Information

NPI Number	:	1972302149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHANIE SUNDLING BS, CADC

Provider Business Mailing Address
First Line	:	3200 W 4TH ST
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51103-3204
Country	:	US
Telephone Number	:	712-258-4578
Fax Number	:

Provider Business Practice Location Address
First Line	:	3200 W 4TH ST
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51103-3204
Country	:	US
Telephone Number	:	712-258-4578
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2025
Last Update Date	:	03/11/2025

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