Healthcare Provider Details

I. General information

NPI: 1235669797
Provider Name (Legal Business Name): BROOKE ROGERS BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2017
Last Update Date: 05/10/2026
Certification Date: 05/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 1/2 ACKER DR
ADA OK
74820-7202
US

IV. Provider business mailing address

111 1/2 ACKER DR
ADA OK
74820-7202
US

V. Phone/Fax

Practice location:
  • Phone: 954-292-0733
  • Fax:
Mailing address:
  • Phone: 954-292-0733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-42706
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: