Provider Demographics
NPI:1952584260
Name:LUND, SHELLY R (LCSW)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:R
Last Name:LUND
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 BARK RIVER DR
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53029-8821
Mailing Address - Country:US
Mailing Address - Phone:262-367-0952
Mailing Address - Fax:
Practice Address - Street 1:385 WILLIAMSTOWNE
Practice Address - Street 2:STE 105
Practice Address - City:DELAFIELD
Practice Address - State:WI
Practice Address - Zip Code:53018-2323
Practice Address - Country:US
Practice Address - Phone:262-370-2778
Practice Address - Fax:262-646-6284
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI27741041C0700X
WI2774-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical