Provider Demographics
NPI:1609168459
Name:LUNDGREN, KRISTINE (SCD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:
Last Name:LUNDGREN
Suffix:
Gender:F
Credentials:SCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 FERGUSON BUILDING
Mailing Address - Street 2:UNIVERSITY OF NORTH CAROLINA AT GREENSBORO
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27402
Mailing Address - Country:US
Mailing Address - Phone:336-334-9858
Mailing Address - Fax:
Practice Address - Street 1:323 FERGUSON BUILDING
Practice Address - Street 2:UNIVERSITY OF NORTH CAROLINA AT GREENSBORO
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27402
Practice Address - Country:US
Practice Address - Phone:336-334-9858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA718018235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist