Provider Demographics
NPI:1194862839
Name:LUNDBOM, TAMMY MARIE
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:MARIE
Last Name:LUNDBOM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2714 NE 205TH AVE APT 228
Mailing Address - Street 2:
Mailing Address - City:FAIRVEW
Mailing Address - State:OR
Mailing Address - Zip Code:97024
Mailing Address - Country:US
Mailing Address - Phone:503-914-9768
Mailing Address - Fax:
Practice Address - Street 1:2714 NE 205TH AVE APT 228
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:OR
Practice Address - Zip Code:97024-9649
Practice Address - Country:US
Practice Address - Phone:503-914-9768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered372600000XNursing Service Related ProvidersAdult Companion
Not Answered171M00000XOther Service ProvidersCase Manager/Care Coordinator