Individual
HANNAH LORRAINE FANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., BCBA, LBA
Contact information
Practice address
1120 MAPLEWOOD LN, WATERLOO, IL 62298-2797
(217) 525-8332
(618) 719-3410
Mailing address
1120 MAPLEWOOD LN, WATERLOO, IL 62298-2797
(618) 719-3410
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103K00000X
Behavior Analyst
Primary
1215462
MO
103K00000X
Behavior Analyst
95001569A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103K00000X
—
MO
Enumeration date
07/27/2020
Last updated
06/24/2026
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