Individual
GINGER KENDELL BRAINARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2970 CHARTRES ST, LA SALLE, IL 61301-1097
(815) 223-0196
(815) 223-0358
Mailing address
2970 CHARTRES ST, LA SALLE, IL 61301-1097
(815) 223-0196
(815) 223-0358
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
071006571
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
071006571
ILLINOIS LICENSE 071006571
IL
Enumeration date
08/29/2012
Last updated
08/29/2012
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