Provider Demographics
NPI:1174976484
Name:GUNDERSON, MELISSA ANNE (LCSW, LICSW)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANNE
Last Name:GUNDERSON
Suffix:
Gender:F
Credentials:LCSW, LICSW
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:BUUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 S SPRING AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-3634
Mailing Address - Country:US
Mailing Address - Phone:605-210-6282
Mailing Address - Fax:605-309-7963
Practice Address - Street 1:100 S SPRING AVE STE 160
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-3634
Practice Address - Country:US
Practice Address - Phone:605-210-6282
Practice Address - Fax:605-309-7963
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-21
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN229791041C0700X
SD60931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN22979OtherCLINICAL LICENSE
SD6093OtherCLINICAL LICENSE