MEDICARE: JOSETTE LUND M.S. CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SP-023	NV

General Provider Information

NPI Number	:	1649621889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSETTE LUND M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	875 RAINBOLT LN
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-0449
Country	:	US
Telephone Number	:	702-451-2307
Fax Number	:	702-565-5011

Provider Business Practice Location Address
First Line	:	1546 W WARM SPRINGS RD STE 110
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89014-4326
Country	:	US
Telephone Number	:	702-565-5011
Fax Number	:	702-565-5012

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2016
Last Update Date	:	06/29/2016

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