Provider Demographics
NPI:1851642334
Name:LUNDGREN, PAULA M (LICSW)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:M
Last Name:LUNDGREN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3221 32ND AVE S
Mailing Address - Street 2:SUITE 700
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-6071
Mailing Address - Country:US
Mailing Address - Phone:701-335-4380
Mailing Address - Fax:701-772-0576
Practice Address - Street 1:3221 32ND AVE S
Practice Address - Street 2:SUITE 700
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-6071
Practice Address - Country:US
Practice Address - Phone:701-335-4380
Practice Address - Fax:701-772-0576
Is Sole Proprietor?:No
Enumeration Date:2012-09-25
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND37251041C0700X
MN172781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical