Provider Demographics
NPI:1316779366
Name:FROGGE, TIFFANY BROOKE (RBT)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:BROOKE
Last Name:FROGGE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:228 EMMANUEL WAY LN
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:KY
Mailing Address - Zip Code:40176-5037
Mailing Address - Country:US
Mailing Address - Phone:310-560-9270
Mailing Address - Fax:270-547-3739
Practice Address - Street 1:402 W LINCOLN TRAIL BLVD STE C
Practice Address - Street 2:
Practice Address - City:RADCLIFF
Practice Address - State:KY
Practice Address - Zip Code:40160-2011
Practice Address - Country:US
Practice Address - Phone:310-560-9270
Practice Address - Fax:270-547-3739
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KYRBT-23-295046106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician