Provider Demographics
NPI:1952563603
Name:LUNDAHL, JOSHUA JOSEPH (MSW)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:JOSEPH
Last Name:LUNDAHL
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2213 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-5305
Mailing Address - Country:US
Mailing Address - Phone:515-237-3974
Mailing Address - Fax:
Practice Address - Street 1:100 E EUCLID AVE
Practice Address - Street 2:SUITE 151
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50313-4511
Practice Address - Country:US
Practice Address - Phone:515-255-8399
Practice Address - Fax:515-255-8405
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA006974104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker