Provider Demographics
NPI:1952009391
Name:LUND, TRISHA RENEE (MSW)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:RENEE
Last Name:LUND
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1823
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54221-1823
Mailing Address - Country:US
Mailing Address - Phone:920-663-1035
Mailing Address - Fax:920-215-4918
Practice Address - Street 1:3733 DEWEY ST
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-5844
Practice Address - Country:US
Practice Address - Phone:920-663-1035
Practice Address - Fax:920-215-4918
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI129987104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI129987-121OtherSOCIAL WORK CERTIFICATION