Provider Demographics
NPI:1679680565
Name:LUND, ERIKA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ERIKA
Middle Name:
Last Name:LUND
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 N CLEVELAND AVE
Mailing Address - Street 2:UNIT A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-8530
Mailing Address - Country:US
Mailing Address - Phone:312-943-3870
Mailing Address - Fax:312-873-4077
Practice Address - Street 1:639 W DIVERSEY PKWY
Practice Address - Street 2:SUITE 214
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1501
Practice Address - Country:US
Practice Address - Phone:312-943-3870
Practice Address - Fax:312-873-4077
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2008-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071005346103TC0700X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1638866OtherBCBS IL
613219100OtherDOL OWCP