Provider Demographics
NPI:1083976559
Name:LUNDBERG, KATIE (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:KATIE
Middle Name:
Last Name:LUNDBERG
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13128 TOTEM LAKE BLVD NE STE 206
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-2953
Mailing Address - Country:US
Mailing Address - Phone:425-229-4920
Mailing Address - Fax:
Practice Address - Street 1:11821 NE 128TH ST STE H
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-7210
Practice Address - Country:US
Practice Address - Phone:206-618-6549
Practice Address - Fax:425-968-6367
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2019-11-27
Deactivation Date:2019-09-24
Deactivation Code:
Reactivation Date:2019-11-27
Provider Licenses
StateLicense IDTaxonomies
WAAC60140585171100000X
WANT60187892175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist