Healthcare Provider Details

I. General information

NPI: 1487568564
Provider Name (Legal Business Name): KAELIN ANN LUNDGREN MA CCC SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 ESPLANADE
CHICO CA
95926-3908
US

IV. Provider business mailing address

1000 W LINDO AVE
CHICO CA
95926-2018
US

V. Phone/Fax

Practice location:
  • Phone: 530-891-3026
  • Fax:
Mailing address:
  • Phone: 530-228-0452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number12465
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: