Provider Demographics
NPI:1750999629
Name:LUNDGREN, CEDAR ROSE (LPC)
Entity type:Individual
Prefix:
First Name:CEDAR
Middle Name:ROSE
Last Name:LUNDGREN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 E 1ST ST APT 1
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55812-1715
Mailing Address - Country:US
Mailing Address - Phone:218-590-0635
Mailing Address - Fax:
Practice Address - Street 1:1611 COUNTY ROAD B W STE 204
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-4053
Practice Address - Country:US
Practice Address - Phone:651-340-4597
Practice Address - Fax:651-493-1105
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2419101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health