Provider Demographics
NPI:1518128248
Name:GREGUSON-LUND, LEZLEE (PHD)
Entity Type:Individual
Prefix:
First Name:LEZLEE
Middle Name:
Last Name:GREGUSON-LUND
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 S MINNESOTA AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-3762
Mailing Address - Country:US
Mailing Address - Phone:605-322-7510
Mailing Address - Fax:605-322-6475
Practice Address - Street 1:4400 W. 69TH ST
Practice Address - Street 2:STE 500
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-8171
Practice Address - Country:US
Practice Address - Phone:605-322-7580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8435103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6552942Medicaid
SD1518128248OtherWELLMARK BCBS SD AND TRICARE
NE10025287200Medicaid
MN1518128248Medicaid
SD9290372OtherDAKOTACARE
SD1518128248OtherWELLMARK BCBS SD AND TRICARE
SD6552942Medicaid