Healthcare Provider Details

I. General information

NPI: 1922878701
Provider Name (Legal Business Name): KYLER JEAN LUNDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2024
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 CORBETT DR
FORT COLLINS CO
80528-9579
US

IV. Provider business mailing address

2695 ROCKY MOUNTAIN AVE STE 150
LOVELAND CO
80538-9071
US

V. Phone/Fax

Practice location:
  • Phone: 970-207-4857
  • Fax: 970-207-4885
Mailing address:
  • Phone: 970-624-2421
  • Fax: 970-490-4156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberCSW.09928887
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: