Mallory Greenbank, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-22-57879 Issued in IL

Practice address

18 N Catherine Ave
La Grange, IL 60525-5930

Phone

(708) 482-9453

NPI assigned

Jul 13, 2021

Last updated

Apr 27, 2022By 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1626134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651017600000",
    "number": "1427620186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18 N CATHERINE AVE",
            "city": "LA GRANGE",
            "state": "IL",
            "postal_code": "605255930",
            "telephone_number": "708-482-9453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18 N CATHERINE AVE",
            "city": "LA GRANGE",
            "state": "IL",
            "postal_code": "605255930",
            "telephone_number": "708-482-9453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREENBANK",
        "first_name": "MALLORY",
        "credential": "BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-13",
        "last_updated": "2022-04-27",
        "certification_date": "2022-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "IL",
            "license": "1-22-57879",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Allison Gonzalez, OT
• Shannon Goold, LCSW
• Gordon Fimreite, DC, S.C.
• Vladislav I Gorengaut, MD
• Dominique Gousset, OTD, OTR/L
• Kimberly Allison Gregoriou, APN
• William H Gros, M.D.
• Tammy Michele Gross-McCoy, PTA
• Jennifer M Gula, O.D.
• Deanne Marie Gustafson

• Behavior Analyst in La Grange, IL
• Providers in La Grange, IL by specialty
• Behavior Analyst in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2022; 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.