Healthcare Provider Details

I. General information

NPI: 1992617773
Provider Name (Legal Business Name): GRACE MACKENZIE ROGERS RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 S 6TH ST # 42071
MURRAY KY
42071-2516
US

IV. Provider business mailing address

90 HOWARD DR
SHELBYVILLE KY
40065-8138
US

V. Phone/Fax

Practice location:
  • Phone: 270-279-7470
  • Fax:
Mailing address:
  • Phone: 270-279-7470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB1474661
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: