Individual
MIA H LUNDERGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA CCC SLP
Contact information
Practice address
901 DOUGLAS AVE, LAS VEGAS, NM 87701-3928
(505) 454-5700
(505) 454-5702
Mailing address
1835 8TH ST, LAS VEGAS, NM 87701-5007
(505) 425-5363
(505) 454-5702
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
564
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
235Z00000X
—
NM
Enumeration date
03/14/2007
Last updated
07/09/2007
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