MEDICARE: SHELLY R LUND LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	2774	WI
2	1041C0700X	Clinical Social Worker	2774-123	WI

General Provider Information

NPI Number	:	1952584260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLY R LUND LCSW

Provider Business Mailing Address
First Line	:	1815 BARK RIVER DR
Second Line	:
City	:	HARTLAND
State	:	WI
Zip	:	53029-8821
Country	:	US
Telephone Number	:	262-367-0952
Fax Number	:

Provider Business Practice Location Address
First Line	:	385 WILLIAMSTOWNE
Second Line	:	STE 105
City	:	DELAFIELD
State	:	WI
Zip	:	53018-2323
Country	:	US
Telephone Number	:	262-370-2778
Fax Number	:	262-646-6284

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2007
Last Update Date	:	05/21/2021

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