Basic Information
| Provider Information | |||||||||
| NPI: | 1740577410 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LUEDTKE | ||||||||
| FirstName: | LINDSEY | ||||||||
| MiddleName: | KRISTINE | ||||||||
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| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7424 BROCK RD | ||||||||
| Address2: | PO BOX 277 | ||||||||
| City: | SPOTSYLVANIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 225532002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405823980 | ||||||||
| FaxNumber: | 5405826825 | ||||||||
| Practice Location | |||||||||
| Address1: | 7427 BROCK ROAD | ||||||||
| Address2: | |||||||||
| City: | SPOTSYLVANIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 225531764 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405823980 | ||||||||
| FaxNumber: | 5405826825 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2011 | ||||||||
| LastUpdateDate: | 07/01/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 0810004416 | VA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.