Healthcare Provider Details

I. General information

NPI: 1326974049
Provider Name (Legal Business Name): JACQUELINE MARY LUDES BRAEGER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9147 RYMARK DR
INDIANAPOLIS IN
46250-1358
US

IV. Provider business mailing address

9147 RYMARK DR
INDIANAPOLIS IN
46250-1358
US

V. Phone/Fax

Practice location:
  • Phone: 317-698-5886
  • Fax:
Mailing address:
  • Phone: 317-698-5886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number35001317A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: