Provider Demographics
NPI:1265086540
Name:LUNDQUIST, ALLIE MARIE
Entity type:Individual
Prefix:
First Name:ALLIE
Middle Name:MARIE
Last Name:LUNDQUIST
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 1:1220 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-2057
Mailing Address - Country:US
Mailing Address - Phone:605-380-9409
Mailing Address - Fax:
Practice Address - Street 1:612 14TH AVE SE
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-7239
Practice Address - Country:US
Practice Address - Phone:605-725-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD844235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist