Provider Demographics
NPI:1548301443
Name:BRADEN, JAYNE A (PSYD)
Entity type:Individual
Prefix:
First Name:JAYNE
Middle Name:A
Last Name:BRADEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 DEKALB AVE
Mailing Address - Street 2:SUITE J
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178
Mailing Address - Country:US
Mailing Address - Phone:815-787-9000
Mailing Address - Fax:815-787-9015
Practice Address - Street 1:2580 DEKALB AVE.
Practice Address - Street 2:SUITE C
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3158
Practice Address - Country:US
Practice Address - Phone:815-787-9000
Practice Address - Fax:815-787-9015
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL07.1006120101YM0800X, 103T00000X
IL07100612101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist