Provider Demographics
NPI:1265675078
Name:MACLEOD, KATHERINE SANDRA (BCBA-D, LBA)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:SANDRA
Last Name:MACLEOD
Suffix:
Gender:F
Credentials:BCBA-D, LBA
Other - Prefix:DR
Other - First Name:K.
Other - Middle Name:SANDRA
Other - Last Name:MACLEOD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BCBA-D, LBA
Mailing Address - Street 1:1915 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98363-1605
Mailing Address - Country:US
Mailing Address - Phone:801-574-4150
Mailing Address - Fax:
Practice Address - Street 1:1915 W 5TH ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98363-1605
Practice Address - Country:US
Practice Address - Phone:801-574-4150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
WABA60761536103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty