Provider Demographics
NPI:1831132810
Name:BRAUHER, RODNEY M (LMSW, PA-C)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:M
Last Name:BRAUHER
Suffix:
Gender:M
Credentials:LMSW, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5781 GRAND RIVER DR
Mailing Address - Street 2:
Mailing Address - City:GRAND LEDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48837-8958
Mailing Address - Country:US
Mailing Address - Phone:517-622-2912
Mailing Address - Fax:517-622-2912
Practice Address - Street 1:1451 RIVER PARK DR STE 260
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4504
Practice Address - Country:US
Practice Address - Phone:657-400-5180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010594651041C0700X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N68490001Medicare ID - Type Unspecified
MI0896030Medicare ID - Type UnspecifiedRODNEY M. BRAUHER CSW
MI0P12570001Medicare ID - Type UnspecifiedIONIA COUNTY CMH
MIR68421Medicare UPIN