Provider Demographics
NPI:1891054821
Name:LUND, KRISTEN M (SLP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:M
Last Name:LUND
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MS
Other - First Name:KRISTEN
Other - Middle Name:M
Other - Last Name:VAN HAGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2719 HAMBURG ST
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12303-3722
Mailing Address - Country:US
Mailing Address - Phone:518-356-8400
Mailing Address - Fax:
Practice Address - Street 1:2719 HAMBURG ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12303-3722
Practice Address - Country:US
Practice Address - Phone:518-356-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-11
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY022076OtherNEW YORK STATE SPEECH-LANGUAGE PATHOLOGIST LICENSE