| Doctor Name: | JUSTIN GUNDERSON |
| NPI Number: | 1598036543 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCSW |
| License Number: | 149-015053 |
| Business Practice Address: | 300 N Kennedy Dr Suite 8 Bradley, IL - 609151559 |
| Business Phone Number: | 8159292009 |
| Business Fax Number: | 8159291284 |
| Mailing Address: | 300 N Kennedy Dr, Suite 8 BRADLEY |
| State: | IL |
| Postal Code: | 609151559 |
| Phone Number: | 8159292009 |
| Fax Number: | 8159291284 |
| NPI Enumeration Date: | 01/23/2012 |
| NPI Last Update Date: | 01/23/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 149-015053 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |