Sundberg, Ellen M
Sundberg, Ellen M is an sole proprietor health care provider with primary practice located at 312 S 25Th Ave , Hattiesburg MS 39401-7301. She recently has only one registered license in Behavioral Health & Social Service Providers / Psychologist, which is considered as her primary health care specialty. Sundberg, Ellen M can be contacted via phone (601) 296-1295.Contact Information
Primary practice address
312 S 25Th Ave
Hattiesburg MS 39401-7301
Phone: (601) 296-1295
Fax: (601) 296-0119
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Psychologist | 103T00000X | 34 560 | Mississippi |
Profile Details
| NPI number | 1194949602 |
|---|---|
| LBN Legal business name | Sundberg, Ellen M |
| Credentials | PH.D. |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Apr 13th, 2007 |
| Last updated | Nov 26th, 2008 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1194949602 | NPPES |
| Mississippi | MEDICAID | 0115948 |
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