Provider Demographics
NPI:1053832428
Name:ROARK, PAULA (BCBA)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:ROARK
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:
Other - Last Name:RUPPEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:9426 PFLUMM RD
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-3308
Mailing Address - Country:US
Mailing Address - Phone:913-608-7005
Mailing Address - Fax:866-308-0972
Practice Address - Street 1:9426 PFLUMM RD
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-3308
Practice Address - Country:US
Practice Address - Phone:913-608-7005
Practice Address - Fax:866-308-0972
Is Sole Proprietor?:No
Enumeration Date:2017-07-06
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSRBT-17-36410106S00000X
KSLBA-00405103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician