Provider Demographics
NPI:1316600273
Name:JUNDT, CJ (CRYSTAL) (DMFT)
Entity Type:Individual
Prefix:DR
First Name:CJ (CRYSTAL)
Middle Name:
Last Name:JUNDT
Suffix:
Gender:F
Credentials:DMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10237 GRAND VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55129-4253
Mailing Address - Country:US
Mailing Address - Phone:701-226-0608
Mailing Address - Fax:
Practice Address - Street 1:6303 OSGOOD AVE N
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-6101
Practice Address - Country:US
Practice Address - Phone:612-470-0240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4224106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist