Provider Demographics
NPI:1346609922
Name:RORK, EMMA (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:RORK
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:
Other - Last Name:ELLENBERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9805 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:OTTAWA LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49267-9751
Mailing Address - Country:US
Mailing Address - Phone:567-201-3557
Mailing Address - Fax:
Practice Address - Street 1:16880 MIDDLEBELT RD STE 1
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-3374
Practice Address - Country:US
Practice Address - Phone:734-371-7101
Practice Address - Fax:855-568-2494
Is Sole Proprietor?:No
Enumeration Date:2016-02-11
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1-15-21085103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst