| Doctor Name: | DR. PATRICIA L. GUNDERSON |
| NPI Number: | 1053393652 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHD |
| License Number: | PY00001727 |
| Business Practice Address: | 850 Maple Street Medical Lake, WA - 990220800 |
| Business Phone Number: | 5095654000 |
| Business Fax Number: | 5095657015 |
| Mailing Address: | 850 Maple Street, P.o. Box 800 MEDICAL LAKE |
| State: | WA |
| Postal Code: | 990220800 |
| Phone Number: | 5095654000 |
| Fax Number: | 5095657015 |
| NPI Enumeration Date: | 11/18/2005 |
| NPI Last Update Date: | 01/29/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PY00001727 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |