| Doctor Name: | THOMAS MICHAEL SURENDONK |
| NPI Number: | 1134292709 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MSSW |
| License Number: | 348-123 |
| Business Practice Address: | 420 1st Ave S Wisconsin Rapids, WI - 544954157 |
| Business Phone Number: | 7154243400 |
| Business Fax Number: | 7154243441 |
| Mailing Address: | Po Box 1535, WISCONSIN RAPIDS |
| State: | WI |
| Postal Code: | 544951535 |
| Phone Number: | 7154243400 |
| Fax Number: | 7154243441 |
| NPI Enumeration Date: | 11/15/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 348-123 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |