Provider Demographics
NPI:1104363829
Name:BRAKEMEIER, STEPHANIE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:BRAKEMEIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 COLFAX AVE NW
Mailing Address - Street 2:PO BOX 115
Mailing Address - City:RENVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56284
Mailing Address - Country:US
Mailing Address - Phone:320-894-2100
Mailing Address - Fax:
Practice Address - Street 1:314 COLFAX AVE NW
Practice Address - Street 2:
Practice Address - City:RENVILLE
Practice Address - State:MN
Practice Address - Zip Code:56284
Practice Address - Country:US
Practice Address - Phone:320-894-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-20
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNTG44251104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker