Provider Demographics
NPI:1629209242
Name:LUNDGREEN, MELINDA R (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:R
Last Name:LUNDGREEN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:MINDY
Other - Middle Name:
Other - Last Name:LUNDGREEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:94 E PAGES LN
Mailing Address - Street 2:#A
Mailing Address - City:CENTERVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84014-2216
Mailing Address - Country:US
Mailing Address - Phone:801-294-0578
Mailing Address - Fax:801-298-2147
Practice Address - Street 1:94 E PAGES LN
Practice Address - Street 2:#A
Practice Address - City:CENTERVILLE
Practice Address - State:UT
Practice Address - Zip Code:84014-2216
Practice Address - Country:US
Practice Address - Phone:801-726-6467
Practice Address - Fax:801-726-6467
Is Sole Proprietor?:No
Enumeration Date:2009-07-30
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7695616-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical