Provider Demographics
NPI:1821417551
Name:LINDGREN, ERIC (CSUDC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:LINDGREN
Suffix:
Gender:M
Credentials:CSUDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 E 300 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-2256
Mailing Address - Country:US
Mailing Address - Phone:801-428-1302
Mailing Address - Fax:
Practice Address - Street 1:745 E 300 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-2256
Practice Address - Country:US
Practice Address - Phone:801-428-1302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8939964-6005324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility