Active NPI
Jean Kay Lundholm, PH D
- Psychologist
- River Falls, WI
National Provider Identifier
1982632733
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 1695 057
- Practice address
- 215 N 2ND St
Suite 101
River Falls, WI 54022-3706 - Phone
- (715) 425-8899
- Fax
- (715) 425-5590
- NPI assigned
- Jun 29, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 1695 057 | WI | Primary |
| Psychologist | 103T00000X | LP1360 | MN |
Addresses
Primary practice location
215 N 2ND St
Suite 101
River Falls, WI 54022-3706
Mailing address
215 N 2ND St
Suite 101
River Falls, WI 54022-3706
Phone (715) 425-8899
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39263900 | Medicaid | WI | |
| 366502 | Other | PREFERRED ONE | |
| 08631LU | Other | BLUE CROSS MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP1360 | MN | MD | Psychologist |
| 1695 057 | WI | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| River Valley Psychological Services Inc | Psychologist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Psychologist
- River Falls, WI
- NPI 1275568271
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151539200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1982632733",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "215 N 2ND ST",
"address_2": "SUITE 101",
"city": "RIVER FALLS",
"state": "WI",
"postal_code": "540223706",
"telephone_number": "715-425-8899",
"fax_number": "715-425-5590"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "215 N 2ND ST",
"address_2": "SUITE 101",
"city": "RIVER FALLS",
"state": "WI",
"postal_code": "540223706",
"telephone_number": "715-425-8899",
"fax_number": "715-425-5590"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUNDHOLM",
"first_name": "JEAN",
"middle_name": "KAY",
"name_prefix": "Mrs.",
"credential": "PH D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "WI",
"license": "1695 057",
"primary": true
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MN",
"license": "LP1360",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "39263900",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "366502",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS MN",
"identifier": "08631LU",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in River Falls, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.