Individual
AUTUMN E BRADDOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
200 1ST ST SW, ROCHESTER, MN 55905-0001
(507) 284-2511
Mailing address
200 1ST ST SW, ROCHESTER, MN 55905-0001
(507) 284-2511
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP4838
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00448266
RAILROAD MEDICARE
MN
Enumeration date
07/12/2007
Last updated
03/13/2008
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