Provider Demographics
NPI:1992165211
Name:BRAIN TRAINING CENTER, LLC
Entity type:Organization
Organization Name:BRAIN TRAINING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:618-599-0534
Mailing Address - Street 1:108 SE 3RD ST
Mailing Address - Street 2:FAIRFIELD, IL 62837
Mailing Address - City:FAIRFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62837-2138
Mailing Address - Country:US
Mailing Address - Phone:618-842-5487
Mailing Address - Fax:
Practice Address - Street 1:1981 IL HIGHWAY 15
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IL
Practice Address - Zip Code:62837-2811
Practice Address - Country:US
Practice Address - Phone:618-599-0534
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-29
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146004676261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech