Provider Demographics
NPI:1407084056
Name:LUND, WESLEY ALLEN (MA)
Entity Type:Individual
Prefix:MR
First Name:WESLEY
Middle Name:ALLEN
Last Name:LUND
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 7TH ST E
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MN
Mailing Address - Zip Code:55033-2101
Mailing Address - Country:US
Mailing Address - Phone:612-432-5698
Mailing Address - Fax:
Practice Address - Street 1:213 SIBLEY ST
Practice Address - Street 2:SUITE 104
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033-1252
Practice Address - Country:US
Practice Address - Phone:612-432-5698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLPC00763101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional