Basic Information
| Provider Information | |||||||||
| NPI: | 1881770121 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WAUNDLESS | ||||||||
| FirstName: | SAUNDRA | ||||||||
| MiddleName: | LYNN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23409 JEFFERSON AVE | ||||||||
| Address2: | #100 | ||||||||
| City: | SAINT CLAIR SHORES | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480803449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5863506967 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2550 S TELEGRAPH RD | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | BLOOMFIELD HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483020950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483220001 | ||||||||
| FaxNumber: | 2483220004 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 6301010104 | MI | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.