Basic Information
| Provider Information | |||||||||
| NPI: | 1750668083 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LUNDE | ||||||||
| FirstName: | KRISTIN | ||||||||
| MiddleName: | ADAIR | ||||||||
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| OtherLastName: | SOHOLT | ||||||||
| OtherFirstName: | KRISTIN | ||||||||
| OtherMiddleName: | ADAIR | ||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 500 CROSS ST | ||||||||
| Address2: | |||||||||
| City: | BIG STONE CITY | ||||||||
| State: | SD | ||||||||
| PostalCode: | 572168237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6055411140 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 645 33RD AVE E | ||||||||
| Address2: | |||||||||
| City: | WEST FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 580788074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7014787868 | ||||||||
| FaxNumber: | 7013567005 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2011 | ||||||||
| LastUpdateDate: | 09/05/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 8760 | MN | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 1161 | ND | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.