| Doctor Name: | GINGER KENDELL BRAINARD |
| NPI Number: | 1871842450 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 071006571 |
| Business Practice Address: | 2970 Chartres St La Salle, IL - 613011097 |
| Business Phone Number: | 8152230196 |
| Business Fax Number: | 8152230358 |
| Mailing Address: | 2970 Chartres St, LA SALLE |
| State: | IL |
| Postal Code: | 613011097 |
| Phone Number: | 8152230196 |
| Fax Number: | 8152230358 |
| NPI Enumeration Date: | 08/29/2012 |
| NPI Last Update Date: | 08/29/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC2200X |
| License Number: | 071006571 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical Child & Adolescent |
| Taxonomy Definition: | |