Provider Demographics
NPI:1891399671
Name:FERN LEAF ABA, LLC
Entity Type:Organization
Organization Name:FERN LEAF ABA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & DIRECTOR; BEHAVIOR ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:E
Authorized Official - Last Name:CRONIN
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:309-253-1683
Mailing Address - Street 1:PO BOX 9667
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61612-9667
Mailing Address - Country:US
Mailing Address - Phone:309-253-1683
Mailing Address - Fax:
Practice Address - Street 1:5739 W MARTINDALE LANE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-9669
Practice Address - Country:US
Practice Address - Phone:309-253-1683
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-23
Last Update Date:2021-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty