Provider Demographics
NPI:1316729858
Name:BRAUNECKER, AVERY MARIE (LSW)
Entity type:Individual
Prefix:MRS
First Name:AVERY
Middle Name:MARIE
Last Name:BRAUNECKER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 PARK HILLS DR
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-3151
Mailing Address - Country:US
Mailing Address - Phone:217-343-3513
Mailing Address - Fax:
Practice Address - Street 1:1001 FORD AVE
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-1701
Practice Address - Country:US
Practice Address - Phone:217-347-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150104070104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker