Provider Demographics
NPI:1881128833
Name:DIAZ, KATHERINE (BCBA)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3430 SW ALICE ST APT 29
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-5363
Mailing Address - Country:US
Mailing Address - Phone:786-547-8145
Mailing Address - Fax:
Practice Address - Street 1:7140 SW FIR LOOP STE 105
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-8062
Practice Address - Country:US
Practice Address - Phone:503-713-8871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-17
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1-22-57841OtherBACB