Provider Demographics
NPI:1255828976
Name:ROGERS-BARAJAS, MADELINE CHRISTINE (MA, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:CHRISTINE
Last Name:ROGERS-BARAJAS
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51320 EVANS WAY
Mailing Address - Street 2:
Mailing Address - City:LA PINE
Mailing Address - State:OR
Mailing Address - Zip Code:97739-8849
Mailing Address - Country:US
Mailing Address - Phone:503-550-9192
Mailing Address - Fax:541-639-8909
Practice Address - Street 1:51320 EVANS WAY
Practice Address - Street 2:
Practice Address - City:LA PINE
Practice Address - State:OR
Practice Address - Zip Code:97739-8849
Practice Address - Country:US
Practice Address - Phone:503-550-9192
Practice Address - Fax:541-639-8909
Is Sole Proprietor?:No
Enumeration Date:2018-04-18
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003842103K00000X
NE0192103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORABA-IN-10204626OtherSTATE REGISTRATION