Provider Demographics
NPI:1679371900
Name:ROGERS, KEETON ANN (RBT)
Entity type:Individual
Prefix:
First Name:KEETON
Middle Name:ANN
Last Name:ROGERS
Suffix:
Gender:
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 SIGLER STREET
Mailing Address - Street 2:
Mailing Address - City:FRANKTON
Mailing Address - State:IN
Mailing Address - Zip Code:46044
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2211 S PARK AVE STE 4&5&7
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:IN
Practice Address - Zip Code:46001-8084
Practice Address - Country:US
Practice Address - Phone:765-705-4138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-24-349926106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician