Provider Demographics
NPI:1881181659
Name:CRONSELL, LAURA AREN (RBT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:AREN
Last Name:CRONSELL
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 W ROOSEVELT ST APT 1
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-3673
Mailing Address - Country:US
Mailing Address - Phone:630-229-2056
Mailing Address - Fax:
Practice Address - Street 1:305 W ROOSEVELT ST APT 1
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-3673
Practice Address - Country:US
Practice Address - Phone:630-229-2056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL18-53676106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician