Provider Demographics
NPI:1336802206
Name:HERRERA, KATELYN (RBT)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:HERRERA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 NE MIRAMAR CIR
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98311-8525
Mailing Address - Country:US
Mailing Address - Phone:360-525-5235
Mailing Address - Fax:
Practice Address - Street 1:5112 NW TAYLOR RD
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-8837
Practice Address - Country:US
Practice Address - Phone:360-373-2536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARBT-21-188718106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician