Staci Lynne Kolko, MS BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-18-30511

Practice address

17206 Lancaster Hwy Ste 501
Charlotte, NC 28277-2004

Phone

(704) 363-3777

NPI assigned

Aug 24, 2018

Last updated

Aug 24, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Staci Lynne Bechard Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

Interoperability endpoints

• Direct secure messaging: staci.kolko@direct.covenantcms.nchie.net

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1535068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1535068800000",
    "number": "1356822696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17206 LANCASTER HWY STE 501",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282772004",
            "telephone_number": "704-363-3777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17206 LANCASTER HWY STE 501",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282772004",
            "telephone_number": "704-363-3777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLKO",
        "first_name": "STACI",
        "middle_name": "LYNNE",
        "credential": "MS BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-24",
        "last_updated": "2018-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": "1-18-30511",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBA #",
            "identifier": "1-18-30511",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACI",
            "last_name": "BECHARD",
            "middle_name": "LYNNE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Julie Michelle Kolczak
• Mark Harris Kolender, MD
• Kristin Julie Kolin, LPC
• Jeanette I. Kolker, PHD
• Kyle Kolkmann, DPT
• Modou L Kolley
• Alexander Kollhoff
• Vamshi Krishna Kolli, M.D.
• Joshua Kollman, D.C.
• Chelsea Kolshak

• Behavior Analyst in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Behavior Analyst in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.