Provider Demographics
NPI:1750994547
Name:BRAUER, ASHLEY (PHD)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:BRAUER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 4TH AVE S
Mailing Address - Street 2:SUITE 5010 PMB 92562
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1053
Mailing Address - Country:US
Mailing Address - Phone:612-268-2493
Mailing Address - Fax:
Practice Address - Street 1:310 4TH AVE S
Practice Address - Street 2:SUITE 5010 PMB 92562
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1053
Practice Address - Country:US
Practice Address - Phone:612-268-2493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY02392401103T00000X
IA115546103T00000X
MNLP6810103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2019037969OtherPROVISIONAL LICENSE NUMBER (MO)
NY02392401OtherLICENSE NUMBER
IA115546OtherLICENSE NUMBER
MNLP6810OtherLICENSE NUMBER