Provider Demographics
NPI:1245481639
Name:BRADDEN, VANESSA R (LMFT)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:R
Last Name:BRADDEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4851 N PAULINA ST
Mailing Address - Street 2:APT 2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-4177
Mailing Address - Country:US
Mailing Address - Phone:773-944-5877
Mailing Address - Fax:
Practice Address - Street 1:4851 N PAULINA ST
Practice Address - Street 2:APT 2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-4177
Practice Address - Country:US
Practice Address - Phone:773-944-5877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-04
Last Update Date:2008-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166000731106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist