Healthcare Provider Details

I. General information

NPI: 1124625546
Provider Name (Legal Business Name): ELISE E ROKKE M.S.ED., BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 01/25/2021
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 PROFESSIONAL CT
LAFAYETTE IN
47905-5152
US

IV. Provider business mailing address

80 PROFESSIONAL CT
LAFAYETTE IN
47905-5152
US

V. Phone/Fax

Practice location:
  • Phone: 765-448-1758
  • Fax:
Mailing address:
  • Phone: 765-448-1758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: