Provider Demographics
NPI:1184942757
Name:BRADEN, JESSICA SUZANNE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:SUZANNE
Last Name:BRADEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-6110
Mailing Address - Country:US
Mailing Address - Phone:785-537-8809
Mailing Address - Fax:785-537-8850
Practice Address - Street 1:1033 S WASHINGTON ST STE 3
Practice Address - Street 2:
Practice Address - City:JUNCTION CITY
Practice Address - State:KS
Practice Address - Zip Code:66441-4783
Practice Address - Country:US
Practice Address - Phone:785-762-4470
Practice Address - Fax:785-762-4495
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
KS7376104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker