Provider Demographics
NPI:1760512792
Name:LUND, KRISTEN AUDREY (MSW LICSW)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:AUDREY
Last Name:LUND
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:AUDREY
Other - Last Name:ATMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:790 CLEVELAND AVE S
Mailing Address - Street 2:SUITE #211
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116
Mailing Address - Country:US
Mailing Address - Phone:612-245-4683
Mailing Address - Fax:
Practice Address - Street 1:790 CLEVELAND AVE S
Practice Address - Street 2:SUITE 211
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116
Practice Address - Country:US
Practice Address - Phone:612-245-4683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN121731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical