Provider Demographics
NPI:1619608072
Name:BRAATEN, MELODY
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:BRAATEN
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 1:7452 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-2650
Mailing Address - Country:US
Mailing Address - Phone:608-234-8331
Mailing Address - Fax:
Practice Address - Street 1:1015 GAMMON LN
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-2210
Practice Address - Country:US
Practice Address - Phone:608-417-8144
Practice Address - Fax:608-417-8145
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7006101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional