Provider Demographics
NPI:1235596768
Name:LA MOTTE-KERR, CAITLIN ALICE BLUM (BCBA)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:ALICE BLUM
Last Name:LA MOTTE-KERR
Suffix:
Gender:
Credentials:BCBA
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:ALICE
Other - Last Name:BLUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18911 PILKINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-8129
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:412 JEFFERSON PKWY STE 202
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035
Practice Address - Country:US
Practice Address - Phone:888-428-3223
Practice Address - Fax:323-866-1881
Is Sole Proprietor?:No
Enumeration Date:2016-01-28
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-15-21054103K00000X
OR1-15-21054103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst