=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730502014
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ABBY BRADEN PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2014
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | DEPARTMENT OF PSYCHOLOGY BOWLING GREEN STATE
-----------------------------------------------------
City | BOWLING GREEN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43403-3021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-372-9405
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | DEPARTMENT OF PSYCHOLOGY BOWLING GREEN STATE UNIVERSITY
-----------------------------------------------------
City | BOWLING GREEN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-372-9405
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 7394
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------