Healthcare Provider Details

I. General information

NPI: 1942164025
Provider Name (Legal Business Name): RAVEN BEHAVIOR ANALYSIS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 CHATHAM RD STE 5966
SPRINGFIELD IL
62704-4188
US

IV. Provider business mailing address

2501 CHATHAM RD STE 5966
SPRINGFIELD IL
62704-4188
US

V. Phone/Fax

Practice location:
  • Phone: 786-848-8979
  • Fax:
Mailing address:
  • Phone: 786-848-8979
  • 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: ANAIS ROSIN
Title or Position: OWNER AND CLINICAL DIRECTOR
Credential: BCBA
Phone: 786-848-8979