Provider Demographics
NPI:1417432881
Name:POLLOK, KENNETH (BCBA, LBA, TLLP)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:POLLOK
Suffix:
Gender:
Credentials:BCBA, LBA, TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 RIDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-6425
Mailing Address - Country:US
Mailing Address - Phone:989-835-6333
Mailing Address - Fax:989-835-4920
Practice Address - Street 1:4285 DEVELOPMENT DR
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4213
Practice Address - Country:US
Practice Address - Phone:517-706-0421
Practice Address - Fax:517-706-0423
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6362009871103TC0700X
MI7401002449103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical