Provider Demographics
NPI:1942899356
Name:THE BRAIN BOUTIQUE, PLLC
Entity Type:Organization
Organization Name:THE BRAIN BOUTIQUE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHNIBBEN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:773-401-0495
Mailing Address - Street 1:815 GEORGETOWN DRIVE, OSWEGO, IL, USA
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-5485
Mailing Address - Country:US
Mailing Address - Phone:773-401-0495
Mailing Address - Fax:
Practice Address - Street 1:50 S MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-5485
Practice Address - Country:US
Practice Address - Phone:773-401-0495
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-12
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty