Provider Demographics
NPI:1992463491
Name:LUNDEBERG, MELANIE MARIE
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:MARIE
Last Name:LUNDEBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MELANIE
Other - Middle Name:MARIE
Other - Last Name:TEGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:320 NE COLUMBIA AVE APT 106C
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OR
Mailing Address - Zip Code:97818-9515
Mailing Address - Country:US
Mailing Address - Phone:503-586-4514
Mailing Address - Fax:
Practice Address - Street 1:104 KINKADE RD
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OR
Practice Address - Zip Code:97818
Practice Address - Country:US
Practice Address - Phone:541-481-2911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health