Basic Information
| Provider Information | |||||||||
| NPI: | 1518128248 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GREGUSON-LUND | ||||||||
| FirstName: | LEZLEE | ||||||||
| MiddleName: | |||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2400 S MINNESOTA AVE | ||||||||
| Address2: | STE 100 | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571053762 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053227510 | ||||||||
| FaxNumber: | 6053226475 | ||||||||
| Practice Location | |||||||||
| Address1: | 4400 W. 69TH ST | ||||||||
| Address2: | STE 500 | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571088171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053227580 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2008 | ||||||||
| LastUpdateDate: | 02/13/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 8435 | NE | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 6552942 | 05 | SD | MEDICAID | 1518128248 | 01 | SD | WELLMARK BCBS SD AND TRICARE | OTHER | 10025287200 | 05 | NE | MEDICAID | 1518128248 | 05 | MN | MEDICAID | 9290372 | 01 | SD | DAKOTACARE | OTHER |