Nick Sundstrom LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

NICK SUNDSTROM LLC

Practice address

2659 SW 4TH St Ste 110
Redmond, OR 97756

Phone

(541) 647-7820

NPI assigned

Mar 19, 2018

Last updated

Oct 5, 2018By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Nicholas Eric Sundstrom, LCSW

Title

Owner/Provider

Phone

(541) 647-7820

Specialties & licenses 3

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1521417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1538697600000",
    "number": "1033613815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2659 SW 4TH ST STE 110",
            "city": "REDMOND",
            "state": "OR",
            "postal_code": "977566406",
            "telephone_number": "541-647-7820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2659 SW 4TH ST STE 110",
            "city": "REDMOND",
            "state": "OR",
            "postal_code": "97756",
            "telephone_number": "541-647-7820"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3659 SW 4th, #110",
            "address_purpose": "LOCATION",
            "city": "Redmond",
            "state": "OR",
            "postal_code": "97756",
            "country_code": "US",
            "telephone_number": "541-903-5822",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NICK SUNDSTROM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-19",
        "last_updated": "2018-10-05",
        "status": "A",
        "authorized_official_last_name": "SUNDSTROM",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_middle_name": "ERIC",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "541-647-7820",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "OR",
            "license": "4413",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "OR",
            "license": "4413",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Redmond, OR
• Providers in Redmond, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.