Individual
JACOB RUNDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
3231 W SHANGRI LA RD, PHOENIX, AZ 85029-4151
(563) 639-4787
Mailing address
3231 W SHANGRI LA RD, PHOENIX, AZ 85029-4151
(636) 394-7875
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LCSW-21992
AZ
104100000X
Social Worker
SWB-2024-0480
NM
Other
Enumeration date
03/02/2021
Last updated
03/11/2026
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