Basic Information
Provider Information
NPI: 1003007550
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCHNEIDER
FirstName: BROOKE
MiddleName: ELLYN
NamePrefix: MS.
NameSuffix:  
Credential: M.S.ED, BCBA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: EINHORN
OtherFirstName: BROOKE
OtherMiddleName: ELLYN
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 4000 GROVE ST
Address2:  
City: SKOKIE
State: IL
PostalCode: 600761712
CountryCode: US
TelephoneNumber: 3129271982
FaxNumber:  
Practice Location
Address1: 4000 GROVE ST
Address2: SUITE 200
City: SKOKIE
State: IL
PostalCode: 600761712
CountryCode: US
TelephoneNumber: 3129271982
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/08/2007
LastUpdateDate: 05/09/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103K00000X1-13-12819 Y Behavioral Health & Social Service ProvidersBehavioral Analyst 
103K00000X ILN Behavioral Health & Social Service ProvidersBehavioral Analyst 

No ID Information.


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