Provider Demographics
NPI:1316070204
Name:LUND, KATE (PSYD)
Entity type:Individual
Prefix:
First Name:KATE
Middle Name:
Last Name:LUND
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 MAGNOLIA LN
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-3474
Mailing Address - Country:US
Mailing Address - Phone:617-512-1992
Mailing Address - Fax:
Practice Address - Street 1:612 MAGNOLIA LN
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-3474
Practice Address - Country:US
Practice Address - Phone:617-512-1992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002748103T00000X
MA8929103TC0700X
WAPY60232876103TC0700X
CA32576103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist