Active NPI
Kirk Gorbach Jr., BCBA
- Behavior Analyst
- Shorewood, WI
National Provider Identifier
1780012799
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 61-140
- Practice address
- 4316 N Woodburn St
Shorewood, WI 53211-1505 - Phone
- (231) 557-6423
- NPI assigned
- Oct 30, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 61-140 | WI | Primary |
Addresses
Primary practice location
4316 N Woodburn St
Shorewood, WI 53211-1505
Mailing address
4316 N Woodburn St
Shorewood, WI 53211-1505
Phone (231) 557-6423
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 61-140 | WI | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1383091200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1383091200000",
"number": "1780012799",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4316 N WOODBURN ST",
"city": "SHOREWOOD",
"state": "WI",
"postal_code": "532111505",
"telephone_number": "231-557-6423"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4316 N WOODBURN ST",
"city": "SHOREWOOD",
"state": "WI",
"postal_code": "532111505",
"telephone_number": "231-557-6423"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORBACH",
"first_name": "KIRK",
"name_suffix": "Jr.",
"credential": "BCBA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-10-30",
"last_updated": "2013-10-30",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "WI",
"license": "61-140",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shorewood, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.