Provider Demographics
NPI:1770832735
Name:LUNDQUIST, ALYSSA K
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:K
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 1:962 STONERIDGE DR STE 2
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-7083
Mailing Address - Country:US
Mailing Address - Phone:406-600-4518
Mailing Address - Fax:406-605-0771
Practice Address - Street 1:962 STONERIDGE DR STE 2
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-7083
Practice Address - Country:US
Practice Address - Phone:406-600-4518
Practice Address - Fax:406-605-0771
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT206543174N00000X
MTSLP-SP-LIC-3183235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No174N00000XOther Service ProvidersLactation Consultant, Non-RN