Provider Demographics
NPI:1194737874
Name:BRAAM, STEVEN JOHN (PHD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:JOHN
Last Name:BRAAM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 391
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105-0391
Mailing Address - Country:US
Mailing Address - Phone:262-716-4955
Mailing Address - Fax:262-767-1275
Practice Address - Street 1:7330 W LAYTON AVE
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-3849
Practice Address - Country:US
Practice Address - Phone:414-281-1677
Practice Address - Fax:414-281-9884
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1635103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39095800Medicaid