Organization
THE BRAIN CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRANDI KRISTEN BOAN PSYD (OWNER)
(630) 649-2819
Entity
Organization
Contact information
Practice address
417 N MAIN ST, SANDWICH, IL 60548-1569
(630) 649-2819
Mailing address
417 N MAIN ST, SANDWICH, IL 60548-1569
(630) 649-2819
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
—
—
103T00000X
Psychologist
Primary
—
—
103TP0016X
Prescribing (Medical) Psychologist
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
09/01/2020
Last updated
12/07/2020
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