Healthcare Provider Details

I. General information

NPI: 1700700994
Provider Name (Legal Business Name): REWIRED PATH PSYCHOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E 5TH AVE STE 235
NAPERVILLE IL
60563-3194
US

IV. Provider business mailing address

300 E 5TH AVE STE 235
NAPERVILLE IL
60563-3194
US

V. Phone/Fax

Practice location:
  • Phone: 630-937-3362
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: AMANDA STAGG
Title or Position: MANAGING MEMBER
Credential: PSYD
Phone: 630-937-3362