Individual
MRS. TASHIE RENAE LUNDBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
435 E 5TH ST, LOVELL, WY 82431-1947
(307) 548-6722
(307) 548-6700
Mailing address
435 E 5TH ST, LOVELL, WY 82431-1947
(307) 548-6722
(307) 548-6700
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP-403
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12027059
ASHA
WY
05
—
1770688871
—
WY
01
—
SP-403
SLP LICENSE
WY
Enumeration date
08/13/2007
Last updated
08/13/2007
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