Healthcare Provider Details

I. General information

NPI: 1235061987
Provider Name (Legal Business Name): ELEMENTAL ABA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 S MULFORD RD
ROCKFORD IL
61108-6725
US

IV. Provider business mailing address

1510 S MULFORD RD
ROCKFORD IL
61108-6725
US

V. Phone/Fax

Practice location:
  • Phone: 708-828-3454
  • Fax:
Mailing address:
  • Phone: 708-828-3454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: DANIELLE HARVEY
Title or Position: OWNER/CLINICAL DIRECTOR/BCBA
Credential: M.S., BCBA, LBA
Phone: 708-828-3454