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General NPI Number Information
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NPI Number | 1417432881
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Entity Type | Individual
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Provider Name | KENNETH POLLOK BCBA, LBA, TLLP
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Gender | Male
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Dates
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Enumeration Date | 10/01/2018
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Last Update Date | 04/14/2025
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Provider Practice Location Address
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Address Line | 4285 DEVELOPMENT DR
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City | LANSING
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State | MI
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Zip | 48911-4213
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Country | US
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Telephone | 517-706-0421
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Fax | 517-706-0423
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Provider Business Mailing Address
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Address Line | 1525 RIDGEWOOD DR
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City | MIDLAND
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State | MI
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Zip | 48642-6425
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Country | US
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Telephone | 989-835-6333
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Fax | 989-835-4920
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6362009871
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 7401002449
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License Number State | MI
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