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NPI Code Detail

MEDICARE: CHASE G LUNDE

MEDICARE: CHASE G LUNDE
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1578149050
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHASE G LUNDE
Provider Business Mailing Address
First Line : 108 VALHALLA DR NE
Second Line :
City : POPLAR GROVE
State : IL
Zip : 61065-9287
Country : US
Telephone Number : 815-997-7634
Fax Number :
Provider Business Practice Location Address
First Line : 8413 COTTONWOOD DR
Second Line :
City : JENISON
State : MI
Zip : 49428-8327
Country : US
Telephone Number : 616-282-9272
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2021
Last Update Date : 09/29/2023

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Directions to “ CHASE G LUNDE ” Practice Location

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