Provider Demographics
NPI:1760653281
Name:RAAD, BRENDA K (LPC)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:K
Last Name:RAAD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 TUMBLEWEED CIRCLE
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095
Mailing Address - Country:US
Mailing Address - Phone:262-335-3289
Mailing Address - Fax:262-375-1071
Practice Address - Street 1:W62N248 WASHINGTON AVE STE 207
Practice Address - Street 2:NORTHSHORE CLINIC AND CONSULTANTS, INC.
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012-2765
Practice Address - Country:US
Practice Address - Phone:262-375-1116
Practice Address - Fax:262-375-1071
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2585-125101YP2500X
WIR300000592801101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool