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NPI Code Detail

MEDICARE: MR. KRISTOFER LUNDEBERG LCSW

MEDICARE: MR. KRISTOFER LUNDEBERG LCSW
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
11041C0700XClinical Social Worker7920999-3501UT

General Provider Information

NPI Number : 1194003186
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KRISTOFER LUNDEBERG LCSW
Provider Business Mailing Address
First Line : 152 N 400 W
Second Line :
City : EPHRAIM
State : UT
Zip : 84627-5549
Country : US
Telephone Number : 435-283-8400
Fax Number : 435-283-8401
Provider Business Practice Location Address
First Line : 152 N 400 W
Second Line :
City : EPHRAIM
State : UT
Zip : 84627-5549
Country : US
Telephone Number : 435-283-8400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2011
Last Update Date : 10/17/2025

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