| Fern Leaf Aba, Llc | |
|
5739 W Martindale Lane Peoria IL 61615-9669 | |
| (309) 253-1683 | |
| Not Available |
| Full Name | Fern Leaf Aba, Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 5739 W Martindale Lane, Peoria, Illinois |
| Authorized Official Name and Position | Anna E Cronin (OWNER & DIRECTOR; BEHAVIOR ANALYST) |
| Authorized Official Contact | 3092531683 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fern Leaf Aba, Llc Po Box 9667 Peoria IL 61612-9667 Ph: (309) 253-1683 | Fern Leaf Aba, Llc 5739 W Martindale Lane Peoria IL 61615-9669 Ph: (309) 253-1683 |
| NPI Number | 1891399671 |
|---|---|
| Provider Enumeration Date | 11/23/2020 |
| Last Update Date | 01/16/2021 |
| Certification Date | 01/16/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891399671 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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