Individual
JAIME GUNDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW, CSAC
Contact information
Practice address
1446 HORICON ST, MAYVILLE, WI 53050-1467
(920) 539-0219
Mailing address
710 N MILWAUKEE ST, THERESA, WI 53091-9716
(920) 539-0219
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
16566-132
WI
104100000X
Social Worker
Primary
131568-121
WI
1041C0700X
Clinical Social Worker
9826-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1164955878
—
WI
Enumeration date
04/10/2017
Last updated
10/23/2022
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