Provider Demographics
NPI:1720321193
Name:EKLUND, LYNDA ELLEN (LSW)
Entity type:Individual
Prefix:
First Name:LYNDA
Middle Name:ELLEN
Last Name:EKLUND
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16201 90TH ST NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OTSEGO
Mailing Address - State:MN
Mailing Address - Zip Code:55330-7463
Mailing Address - Country:US
Mailing Address - Phone:763-633-3800
Mailing Address - Fax:
Practice Address - Street 1:16201 90TH ST NE
Practice Address - Street 2:SUITE 100
Practice Address - City:OTSEGO
Practice Address - State:MN
Practice Address - Zip Code:55330-7463
Practice Address - Country:US
Practice Address - Phone:763-633-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLSW16535104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker