Provider Demographics
NPI:1568754158
Name:BARANOWSKI, BRAD E (MS)
Entity Type:Individual
Prefix:MR
First Name:BRAD
Middle Name:E
Last Name:BARANOWSKI
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6629 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-3037
Mailing Address - Country:US
Mailing Address - Phone:608-833-5880
Mailing Address - Fax:608-829-3787
Practice Address - Street 1:6629 UNIVERSITY AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-3037
Practice Address - Country:US
Practice Address - Phone:608-833-5880
Practice Address - Fax:608-829-3787
Is Sole Proprietor?:No
Enumeration Date:2011-05-14
Last Update Date:2011-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4321-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional