Provider Demographics
NPI:1750668083
Name:LUNDE, KRISTIN ADAIR
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ADAIR
Last Name:LUNDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:ADAIR
Other - Last Name:SOHOLT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 CROSS ST
Mailing Address - Street 2:
Mailing Address - City:BIG STONE CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57216-8237
Mailing Address - Country:US
Mailing Address - Phone:605-541-1140
Mailing Address - Fax:
Practice Address - Street 1:645 33RD AVE E
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-8074
Practice Address - Country:US
Practice Address - Phone:701-478-7868
Practice Address - Fax:701-356-7005
Is Sole Proprietor?:No
Enumeration Date:2011-11-15
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8760235Z00000X
ND1161235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist