Provider Demographics
NPI:1962938241
Name:LUNDGREN, KIMBERLEE
Entity type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:
Last Name:LUNDGREN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1845
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98668-1845
Mailing Address - Country:US
Mailing Address - Phone:360-397-8484
Mailing Address - Fax:360-397-8494
Practice Address - Street 1:PO BOX 272
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:WA
Practice Address - Zip Code:98642-0272
Practice Address - Country:US
Practice Address - Phone:360-433-9664
Practice Address - Fax:360-326-7224
Is Sole Proprietor?:No
Enumeration Date:2017-05-05
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health