AMBER POLK (NPI# 1255979001) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255979001 |
| Entity Type | Individual |
| Full Name | AMBER POLK |
| Practice Address |
1220 S Sunset Ave Rockford IL 61102-2649 |
| Practice Telephone | 8473069834 |
| Mailing Telephone | 7792005047 |
| Enumeration Date | 2019-12-11 |
| Last Update Date | 2019-12-11 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 106S00000X | Behavior Technician | IL | Behavioral Health & Social Service Providers |
| Street Address |
1220 S SUNSET AVE |
| City | ROCKFORD |
| State | IL |
| Zip Code | 61102-2649 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205115383 | Renee Lynn Keeney | Advanced Practice Midwife | 1200 W. State Street, Crusader Community Health, Rockford, IL 61102 | 2011-08-08 |
| 1689895906 | Linda Lou O'reilly | Local Education Agency (LEA) | 1515 S. Meridian Road, Rockford, IL 61102 | 2007-05-02 |
| 1801012992 | Jennifer Anne Boyd | Developmental Therapist | Nia 1515 S. Meridian Rd., Rockford, IL 61102 | 2007-04-17 |
| 1447751623 | Cynthia Uwase | Dentist | 1200 W State St, Rockford, IL 61102 | 2018-02-23 |
| 1033591847 | Jithinraj Edakkanambeth Varayil | Family Medicine | 1200 W State St, Rockford, IL 61102 | 2015-06-29 |
| 1194106849 | Naomi Thompson | Family Medicine | 1200 W State St, Rockford, IL 61102 | 2015-06-17 |
| 1811377617 | Serene Antoinette Bethune | Family Medicine | 1200 W State St, Rockford, IL 61102 | 2015-06-05 |
| 1013188408 | Gary Patrick Fernando | Pediatrics | 1200 W State St, Rockford, IL 61102 | 2008-03-13 |
| 1265602130 | Martin A Ganan | Pharmacist | 1200 W State St, Pharmacy, Rockford, IL 61102 | 2008-03-07 |
| 1609173434 | Kellie J Gibbons | Registered Nurse | 650 W State Street, Winnebago County Jail Medical Unit, Rockford, IL 61102-0000 | 2011-02-14 |
| Find all providers in zip 61102 | ||||
| Taxonomy Code | 106S00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Behavior Technician |
| The behavior technician is a paraprofessional who practices under the close, ongoing supervision of a behavior analyst or assistant behavior analyst certified by the Behavior Analyst Certification Board and/or credentialed by a state (such as through licensure). The behavior technician is primarily responsible for the implementation of components of behavior-analytic treatment plans developed by the supervisor. That may include collecting data on treatment targets and conducting certain types of behavioral assessments (e.g., stimulus preference assessments). The behavior technician does not design treatment or assessment plans or procedures but provides services as assigned by the supervisor responsible for his or her work. |
| Notes: Association of Professional Behavior Analysts, www.apbahome.net and Behavior Analyst Certification Board (http://www.bacb.com) [7/1/2016: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447875257 | Lauren Mast | Behavior Technician | 20 S Fremont St Ne, Rockford, MI 49341-1210 | 2020-06-08 |
| 1083242788 | Elexus Jade Fournier | Behavior Technician | 7177 Crimson Ridge Dr Ste 110, Rockford, IL 61107-6235 | 2020-03-29 |
| 1558994293 | Evan Donald Demara | Behavior Technician | 552 Orchard Dr Ne, Rockford, MI 49341-7205 | 2020-02-21 |
| 1548804594 | Elysia Marie Ray | Behavior Technician | 2421 Kobel Ct, Rockford, IL 61102-2518 | 2019-11-02 |
| 1578129292 | Corey Llewellyn Krieg | Behavior Technician | 8565 Courtland Dr Ne, Rockford, MI 49341-8265 | 2019-05-17 |
| 1851850242 | Colleena Sue Smith | Behavior Technician | 2809 Halsted Rd Apt B, Rockford, IL 61101-2855 | 2019-03-15 |
| 1295206340 | Amanda Denise Branney | Behavior Technician | 1135 Woodridge Dr, Rockford, IL 61108-4016 | 2018-12-16 |
| 1184195273 | Jill Frances Smith | Behavior Technician | 2212 Canary Dr Unit E, Rockford, IL 61103-1928 | 2018-12-16 |
| 1922576172 | Ashley Elainah Lewis | Behavior Technician | 3207 Louise St, Rockford, IL 61103-3020 | 2018-11-06 |
| 1851883326 | Kirstin Journey Porter | Behavior Technician | 1042 Lundvall Ave, Rockford, IL 61107-3338 | 2018-05-31 |
| Find all providers in ROCKFORD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.