Provider Demographics
NPI:1578149050
Name:LUNDE, CHASE G
Entity Type:Individual
Prefix:
First Name:CHASE
Middle Name:G
Last Name:LUNDE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 VALHALLA DR NE
Mailing Address - Street 2:
Mailing Address - City:POPLAR GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:61065-9287
Mailing Address - Country:US
Mailing Address - Phone:815-997-7634
Mailing Address - Fax:
Practice Address - Street 1:8413 COTTONWOOD DR
Practice Address - Street 2:
Practice Address - City:JENISON
Practice Address - State:MI
Practice Address - Zip Code:49428-8327
Practice Address - Country:US
Practice Address - Phone:616-282-9272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician