Healthcare Provider Details

I. General information

NPI: 1821067869
Provider Name (Legal Business Name): JULIE A LUNDE SEVICK PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 02/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 E 2ND ST DULUTH CLINIC FITNESS AND THERAPY CENTER
DULUTH MN
55805
US

IV. Provider business mailing address

402 E 2ND ST
DULUTH MN
55805-1906
US

V. Phone/Fax

Practice location:
  • Phone: 218-786-1561
  • Fax: 218-786-1561
Mailing address:
  • Phone: 218-786-5410
  • Fax: 218-786-1561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP4629
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: