Provider Demographics
NPI:1154862498
Name:REXROAT, KATIE (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:REXROAT
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15982 SW ROTH DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97078-2101
Mailing Address - Country:US
Mailing Address - Phone:909-997-6529
Mailing Address - Fax:
Practice Address - Street 1:12155 SW TOOZE RD
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-8441
Practice Address - Country:US
Practice Address - Phone:503-570-0147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1-20-44236103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst