Active NPI
Katelyn Marissa Malcore, MS, BCBA
- Behavior Analyst
- Coon Rapids, MN
National Provider Identifier
1184182289
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 1-23-68595
- Practice address
- 9120 Springbrook Dr NW
Coon Rapids, MN 55433-5845 - Phone
- (952) 767-7222
- NPI assigned
- Mar 7, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | |||
| Behavior Analyst | 103K00000X | 1-23-68595 | MN | Primary |
Addresses
Primary practice location
9120 Springbrook Dr NW
Coon Rapids, MN 55433-5845
Mailing address
9120 Springbrook Dr NW
Coon Rapids, MN 55433-5845
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1551916800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1696982400000",
"number": "1184182289",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9120 SPRINGBROOK DR NW",
"city": "COON RAPIDS",
"state": "MN",
"postal_code": "554335845"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9120 SPRINGBROOK DR NW",
"city": "COON RAPIDS",
"state": "MN",
"postal_code": "554335845",
"telephone_number": "952-767-7222"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALCORE",
"first_name": "KATELYN",
"middle_name": "MARISSA",
"credential": "MS, BCBA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-03-07",
"last_updated": "2023-10-11",
"certification_date": "2023-10-11",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": false
},
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "MN",
"license": "1-23-68595",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Coon Rapids, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.