Provider Demographics
NPI:1841949476
Name:LUNDGREN, JAYNA
Entity type:Individual
Prefix:
First Name:JAYNA
Middle Name:
Last Name:LUNDGREN
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 1:5600 CAMERATA WAY UNIT 316
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-5290
Mailing Address - Country:US
Mailing Address - Phone:651-492-1096
Mailing Address - Fax:
Practice Address - Street 1:4660 SLATER RD STE 120
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-4048
Practice Address - Country:US
Practice Address - Phone:651-492-1096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health