Provider Demographics
NPI:1447862230
Name:DORMAN, KATHARINE (MAT, BCBA, LBA)
Entity type:Individual
Prefix:MRS
First Name:KATHARINE
Middle Name:
Last Name:DORMAN
Suffix:
Gender:F
Credentials:MAT, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3995 MARCOLA RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-7948
Mailing Address - Country:US
Mailing Address - Phone:541-726-1465
Mailing Address - Fax:541-726-1465
Practice Address - Street 1:360 S GARDEN WAY STE 250
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-8175
Practice Address - Country:US
Practice Address - Phone:541-726-1466
Practice Address - Fax:541-726-5085
Is Sole Proprietor?:No
Enumeration Date:2020-08-21
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
VA0133001642103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst