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NPI Code Detail

MEDICARE: MS. SAMANTHA LYNN BRADEN AUD

MEDICARE: MS. SAMANTHA LYNN BRADEN AUD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1231H00000XAudiologist147012286IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1538896774
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SAMANTHA LYNN BRADEN AUD
Provider Business Mailing Address
First Line : PO BOX 7412011
Second Line :
City : CHICAGO
State : IL
Zip : 60674-2011
Country : US
Telephone Number : 618-235-3687
Fax Number : 618-239-9429
Provider Business Practice Location Address
First Line : 19 WOLF CREEK DR
Second Line : DEPT OTOLARYNGOLOGY
City : SWANSEA
State : IL
Zip : 62226-2355
Country : US
Telephone Number : 618-235-3687
Fax Number : 618-239-9429
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2022
Last Update Date : 02/20/2026

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