MEDICARE: DR. CJ (CRYSTAL) JUNDT DMFT

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	106H00000X	Marriage & Family Therapist	4224	MN

General Provider Information

NPI Number	:	1316600273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CJ (CRYSTAL) JUNDT DMFT

Provider Business Mailing Address
First Line	:	10237 GRAND VALLEY LN
Second Line	:
City	:	WOODBURY
State	:	MN
Zip	:	55129-4253
Country	:	US
Telephone Number	:	701-226-0608
Fax Number	:

Provider Business Practice Location Address
First Line	:	10237 GRAND VALLEY LN
Second Line	:
City	:	WOODBURY
State	:	MN
Zip	:	55129-4253
Country	:	US
Telephone Number	:	701-226-0608
Fax Number	:

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

Provider Enumeration Date	:	10/18/2021
Last Update Date	:	08/07/2024

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