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NPI Code Detail

MEDICARE: KENNETH POLLOK BCBA, LBA, TLLP

MEDICARE: KENNETH POLLOK BCBA, LBA, TLLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist6362009871MI
2103K00000XBehavior Analyst7401002449MI

General Provider Information

NPI Number : 1417432881
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNETH POLLOK BCBA, LBA, TLLP
Provider Business Mailing Address
First Line : 1525 RIDGEWOOD DR
Second Line :
City : MIDLAND
State : MI
Zip : 48642-6425
Country : US
Telephone Number : 989-835-6333
Fax Number : 989-835-4920
Provider Business Practice Location Address
First Line : 4285 DEVELOPMENT DR
Second Line :
City : LANSING
State : MI
Zip : 48911-4213
Country : US
Telephone Number : 517-706-0421
Fax Number : 517-706-0423
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/01/2018
Last Update Date : 04/14/2025

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