Provider Demographics
NPI:1144971300
Name:PATRICK R. GUNDERSON, PH.D., PLLC
Entity type:Organization
Organization Name:PATRICK R. GUNDERSON, PH.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:R
Authorized Official - Last Name:GUNDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:847-778-7365
Mailing Address - Street 1:3236 N LEAVITT ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-6341
Mailing Address - Country:US
Mailing Address - Phone:847-778-7365
Mailing Address - Fax:
Practice Address - Street 1:2030 E ALGONQUIN RD STE 401
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4159
Practice Address - Country:US
Practice Address - Phone:847-778-7365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health