Provider Demographics
NPI:1013040146
Name:LUNDBECK, DANA STEWART (MA)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:STEWART
Last Name:LUNDBECK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20725 SE 162ND WAY
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-9073
Mailing Address - Country:US
Mailing Address - Phone:425-761-2355
Mailing Address - Fax:
Practice Address - Street 1:20725 SE 162ND WAY
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98059-9073
Practice Address - Country:US
Practice Address - Phone:425-761-2355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00000864106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist