Provider Demographics
NPI:1326763400
Name:LUNDSTROM, ASHLEY MARIE (LMSW)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MARIE
Last Name:LUNDSTROM
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 NW 55TH PL
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50313-1346
Mailing Address - Country:US
Mailing Address - Phone:515-681-7646
Mailing Address - Fax:
Practice Address - Street 1:1105 N ANKENY BLVD
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-4003
Practice Address - Country:US
Practice Address - Phone:515-255-8399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA101825104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker