Provider Demographics
NPI:1417491598
Name:YEATON, KATHARINE WARFIELD (CADC 1, CRM)
Entity Type:Individual
Prefix:MS
First Name:KATHARINE
Middle Name:WARFIELD
Last Name:YEATON
Suffix:
Gender:F
Credentials:CADC 1, CRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7814 N FOWLER AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-5933
Mailing Address - Country:US
Mailing Address - Phone:503-791-9603
Mailing Address - Fax:
Practice Address - Street 1:22018 S CENTRAL POINT RD
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-8705
Practice Address - Country:US
Practice Address - Phone:503-791-9603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR106S00000XOtherUNKNOWN DESIGNATION