Jill Lynn Walck, M. ED. BCBA LBS

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

BH004722 Issued in PA

Practice address

283 Butler Rd
Mount Gretna, PA 17064-6085

Phone

(717) 945-4359

NPI assigned

Aug 15, 2012

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

State licenses

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

{
    "created_epoch": "1344988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601337600000",
    "number": "1518215003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 550",
            "city": "MOUNT GRETNA",
            "state": "PA",
            "postal_code": "170640550",
            "telephone_number": "717-945-4359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "283 BUTLER RD",
            "city": "MOUNT GRETNA",
            "state": "PA",
            "postal_code": "170646085",
            "telephone_number": "717-945-4359"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2708 NE 14th St",
            "address_2": "Suite 5",
            "address_purpose": "LOCATION",
            "city": "Pompano Beach",
            "state": "FL",
            "postal_code": "330623565",
            "country_code": "US",
            "telephone_number": "888-880-9270",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALCK",
        "first_name": "JILL",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "M. ED. BCBA LBS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-15",
        "last_updated": "2020-09-29",
        "certification_date": "2020-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "PA",
            "license": "BH004722",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Taylor, LPC
• Taylor Marie Tyneway
• Karen L Vergano, APRN BC
• Saunja Margaret Vicari, MS, BCBA, LBS
• Ronald G Vogt, PHD
• Wellspan Philhaven Residential
• Ralph G Whitaker, PHD
• Hope Witmer, PHD
• Sara J Wright, LSW
• Jahanara Zahid, M.D.

• All providers in Mount Gretna, PA
• Behavior Analyst in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2020; 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.