Individual
E JOLENE LUND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AUD
Contact information
Practice address
1970 E 17TH ST STE 119, IDAHO FALLS, ID 83404-8046
(208) 522-3141
(208) 542-1112
Mailing address
1970 E 17TH ST STE 119, IDAHO FALLS, ID 83404-8046
(208) 522-3141
(208) 542-1112
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
5888664-4101
UT
237600000X
Audiologist-Hearing Aid Fitter
AUD-2064
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15814444
MEDICARE
ID
01
—
1831490507
IDAHO MEDICAID
ID
01
—
7149398
WA MEDICAID
WA
Enumeration date
11/10/2010
Last updated
07/21/2022
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