Provider Demographics
NPI:1801954474
Name:LUND, ERIC JOHN (PSYD, BCBA-D, AND A)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:JOHN
Last Name:LUND
Suffix:
Gender:M
Credentials:PSYD, BCBA-D, AND A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 ALLOUEZ AVE
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-5639
Mailing Address - Country:US
Mailing Address - Phone:920-857-9041
Mailing Address - Fax:920-857-3366
Practice Address - Street 1:1575 ALLOUEZ AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-5639
Practice Address - Country:US
Practice Address - Phone:920-857-9041
Practice Address - Fax:920-857-3366
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1871057103TC0700X
WI1-08-4429103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1801954474Medicaid