Individual
DR. ELLEN M SUNDBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
312 S 25TH AVE, HATTIESBURG, MS 39401-7301
(601) 296-1295
(601) 296-0119
Mailing address
PO BOX 17743, HATTIESBURG, MS 39404-7743
(601) 296-1295
(601) 296-0119
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
34 560
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0115948
—
MS
Enumeration date
04/13/2007
Last updated
11/26/2008
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