=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124948302
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALISHA DIANNE ROGERS RBT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2026
-----------------------------------------------------
Last Update Date | 07/17/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6203 S LEMAY AVE
-----------------------------------------------------
City | FORT COLLINS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80525-9436
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-295-3790
-----------------------------------------------------
Fax | 877-400-4480
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4019 DENVER ST
-----------------------------------------------------
City | EVANS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80620-2929
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-295-3790
-----------------------------------------------------
Fax | 877-400-4480
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------