Provider Demographics
NPI:1427884311
Name:KRAKAU, BRADY W
Entity type:Individual
Prefix:
First Name:BRADY
Middle Name:W
Last Name:KRAKAU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 W BURNHAM ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68522-9224
Mailing Address - Country:US
Mailing Address - Phone:402-833-8160
Mailing Address - Fax:
Practice Address - Street 1:1620 W BURNHAM ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68522-9224
Practice Address - Country:US
Practice Address - Phone:402-833-8160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE14054101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health