Provider Demographics
NPI:1124401740
Name:DOMAGALA, KATHERINE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:
Last Name:DOMAGALA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 OAK ST
Mailing Address - Street 2:# 4
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-7726
Mailing Address - Country:US
Mailing Address - Phone:541-371-2782
Mailing Address - Fax:
Practice Address - Street 1:1441 OAK ST
Practice Address - Street 2:# 4
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-7726
Practice Address - Country:US
Practice Address - Phone:541-371-2782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2016-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13304235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500689352Medicaid