Provider Demographics
NPI:1770664278
Name:LUNDBERG, MARALEE R
Entity Type:Individual
Prefix:MRS
First Name:MARALEE
Middle Name:R
Last Name:LUNDBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5436 E CHARLESTON AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-5820
Mailing Address - Country:US
Mailing Address - Phone:602-819-0807
Mailing Address - Fax:602-788-6766
Practice Address - Street 1:5436 E CHARLESTON AVE
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-5820
Practice Address - Country:US
Practice Address - Phone:602-819-0807
Practice Address - Fax:602-788-6766
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPL0988235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ568909Medicaid