Healthcare Provider Details

I. General information

NPI: 1053832428
Provider Name (Legal Business Name): PAULA ROARK BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAULA RUPPEL BCBA

II. Dates (important events)

Enumeration Date: 07/06/2017
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9426 PFLUMM RD
LENEXA KS
66215-3308
US

IV. Provider business mailing address

9426 PFLUMM RD
LENEXA KS
66215-3308
US

V. Phone/Fax

Practice location:
  • Phone: 913-608-7005
  • Fax: 866-308-0972
Mailing address:
  • Phone: 913-608-7005
  • Fax: 866-308-0972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-17-36410
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA-00405
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: