| Doctor Name: | MRS. JESSICA SUNDHOLM |
| NPI Number: | 1912354754 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 7101001121 |
| Business Practice Address: | 301 Williamston Center Rd. Suite 800 Williamston, MI - 48895 |
| Business Phone Number: | 5176552327 |
| Business Fax Number: | 5176552442 |
| Mailing Address: | 1330 E. Grand River Ave, Suite B PORTLAND |
| State: | MI |
| Postal Code: | 48875 |
| Phone Number: | 5176474327 |
| Fax Number: | 5176472442 |
| NPI Enumeration Date: | 05/23/2016 |
| NPI Last Update Date: | 05/23/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 7101001121 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |