Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | IL |
NPI | 1316056518 |
---|---|
Provider Name | Dr. Ronald Walter Braasch JR. |
First Address | Elmhurst, IL 60126-2332 |
Second Address | North Chicago, IL 60064 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 08/07/2007 |