Provider Demographics
NPI:1316056518
Name:BRAASCH, RONALD WALTER JR (PHD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:WALTER
Last Name:BRAASCH
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:301 N MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2332
Mailing Address - Country:US
Mailing Address - Phone:847-688-1900
Mailing Address - Fax:224-610-3778
Practice Address - Street 1:3001 GREEN BAY ROAD
Practice Address - Street 2:BUILDING 11
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064
Practice Address - Country:US
Practice Address - Phone:847-688-1900
Practice Address - Fax:224-610-3778
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)