Provider Demographics
NPI:1356463418
Name:LUND, JOAN DIEDRICK (PSYD, LP)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:DIEDRICK
Last Name:LUND
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9508 BRUNSWICK CIR
Mailing Address - Street 2:2450 RIVERSIDE AVENUE SOUTH, MINNEAPOLIS MN 55438
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55438-1702
Mailing Address - Country:US
Mailing Address - Phone:612-273-9115
Mailing Address - Fax:612-273-9110
Practice Address - Street 1:2450 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1450
Practice Address - Country:US
Practice Address - Phone:612-672-6000
Practice Address - Fax:612-273-9110
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3795103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist