Individual
DR. JESSIE J. LUNDQUIST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
224 N CAMINO DEL PUEBLO, BERNALILLO, NM 87004-6146
(505) 404-5238
Mailing address
17 RANCHO PRIMAVERA, SANDIA PARK, NM 87047-9621
(970) 420-4668
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
336140
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14457890
—
NM
Enumeration date
05/19/2010
Last updated
05/19/2010
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