Provider Demographics
NPI:1174768782
Name:LUNDELL, CAROLYN ANN (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:ANN
Last Name:LUNDELL
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8757 E DRY CREEK RD
Mailing Address - Street 2:UNIT 1524
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-2789
Mailing Address - Country:US
Mailing Address - Phone:651-815-3300
Mailing Address - Fax:
Practice Address - Street 1:867 CLEVELAND AVE S
Practice Address - Street 2:APT. 12
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-1895
Practice Address - Country:US
Practice Address - Phone:651-492-9425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-10
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8148235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist