Provider Demographics
NPI:1033088802
Name:STOCKERT, BRAYDON (LGSW)
Entity type:Individual
Prefix:
First Name:BRAYDON
Middle Name:
Last Name:STOCKERT
Suffix:
Gender:M
Credentials:LGSW
Other - Prefix:
Other - First Name:BRADY
Other - Middle Name:
Other - Last Name:STOCKERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1686 FORD PKWY
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-2198
Mailing Address - Country:US
Mailing Address - Phone:701-220-4961
Mailing Address - Fax:
Practice Address - Street 1:6 PINE TREE DR STE 290-295
Practice Address - Street 2:
Practice Address - City:ARDEN HILLS
Practice Address - State:MN
Practice Address - Zip Code:55112-3745
Practice Address - Country:US
Practice Address - Phone:952-698-5600
Practice Address - Fax:952-698-5599
Is Sole Proprietor?:No
Enumeration Date:2025-10-31
Last Update Date:2025-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN35063104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker