Provider Demographics
NPI:1467009365
Name:BRAUDT, JAELYN JAE
Entity Type:Individual
Prefix:
First Name:JAELYN
Middle Name:JAE
Last Name:BRAUDT
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 1:310 EDITH ST
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-1228
Mailing Address - Country:US
Mailing Address - Phone:608-822-5090
Mailing Address - Fax:
Practice Address - Street 1:3485 WINDSOR AVE
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-1329
Practice Address - Country:US
Practice Address - Phone:608-822-5090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-25
Last Update Date:2019-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2992-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant