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1575 Allouez Ave Green Bay WI 54311-5639 | |
| (920) 857-9041 | |
| (920) 857-3366 |
| Full Name | |
|---|---|
| Speciality | Behavior Analyst |
| Location | 1575 Allouez Ave, Green Bay, Wisconsin |
| Authorized Official Name and Position | Eric John Lund (PRESIDENT/CCO) |
| Authorized Official Contact | 9208572577 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1575 Allouez Ave Green Bay WI 54311-5639 Ph: (920) 857-9041 | 1575 Allouez Ave Green Bay WI 54311-5639 Ph: (920) 857-9041 |
| NPI Number | 1588993091 |
|---|---|
| Provider Enumeration Date | 12/11/2009 |
| Last Update Date | 01/14/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588993091 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | 1-08-4429 (Wisconsin) | Primary |
| 103TC0700X | Psychologist - Clinical | 1871-57 (Wisconsin) | Secondary |
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