Provider Demographics
NPI:1225812902
Name:BRADEN, EMILY MARIE (MS)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:MARIE
Last Name:BRADEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:MARIE
Other - Last Name:BLADES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16176 COUNTY ROAD 1900 N
Mailing Address - Street 2:
Mailing Address - City:SPRINGERTON
Mailing Address - State:IL
Mailing Address - Zip Code:62887-2154
Mailing Address - Country:US
Mailing Address - Phone:618-384-8998
Mailing Address - Fax:
Practice Address - Street 1:806 N 1ST ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IL
Practice Address - Zip Code:62837-2458
Practice Address - Country:US
Practice Address - Phone:618-384-8998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2519064235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist