Provider Demographics
NPI:1134268980
Name:LUND, MARCI KIM (AUD, F-AAA, CCC-)
Entity type:Individual
Prefix:
First Name:MARCI
Middle Name:KIM
Last Name:LUND
Suffix:
Gender:F
Credentials:AUD, F-AAA, CCC-
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 N 7TH AVE STE H
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-2567
Mailing Address - Country:US
Mailing Address - Phone:406-586-0914
Mailing Address - Fax:406-586-6667
Practice Address - Street 1:1008 N 7TH AVE STE H
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-2567
Practice Address - Country:US
Practice Address - Phone:406-586-0914
Practice Address - Fax:406-586-6667
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR0000WFBTVOtherGROUP MEDICARE - NORTH BEND MEDICAL CENTER
OR161133OtherGROUP DMAP-MEDICAID
OR1407812365OtherGROUP NPI - NORTH BEND MEDICAL CENTER