| Doctor Name: | DR. JESSIE J. LUNDQUIST |
| NPI Number: | 1396064168 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHD |
| License Number: | 336140 |
| Business Practice Address: | 224 N Camino Del Pueblo Bernalillo, NM - 870046146 |
| Business Phone Number: | 5054045238 |
| Business Fax Number: | |
| Mailing Address: | 17 Rancho Primavera, SANDIA PARK |
| State: | NM |
| Postal Code: | 870479621 |
| Phone Number: | 9704204668 |
| Fax Number: | |
| NPI Enumeration Date: | 05/19/2010 |
| NPI Last Update Date: | 05/19/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TS0200X |
| License Number: | 336140 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |