Healthcare Provider Details

I. General information

NPI: 1962671156
Provider Name (Legal Business Name): JANE ANNE BRAUN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2008
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20635 ABBEY WOODS CT N STE 303
FRANKFORT IL
60423-3191
US

IV. Provider business mailing address

8417 CRESTWOOD AVE
MUNSTER IN
46321-2011
US

V. Phone/Fax

Practice location:
  • Phone: 708-372-7286
  • Fax: 219-301-7159
Mailing address:
  • Phone: 219-838-3235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071007169
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number071007169
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number071007169
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number071007169
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number071007169
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: