Provider Demographics
NPI:1407204860
Name:LUNDGREN, JENNIFER D (PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:D
Last Name:LUNDGREN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:5030 CHERRY ST
Mailing Address - Street 2:ROOM 321
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64110-2232
Mailing Address - Country:US
Mailing Address - Phone:816-235-5384
Mailing Address - Fax:816-235-1082
Practice Address - Street 1:8400 W 110TH ST
Practice Address - Street 2:STE. 610
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2331
Practice Address - Country:US
Practice Address - Phone:913-631-3800
Practice Address - Fax:913-948-7317
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS2400103TC0700X
MO2006036651103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical