Healthcare Provider Details

I. General information

NPI: 1295666105
Provider Name (Legal Business Name): KATHERINE WATSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 WILLOW PASS RD STE 628
CONCORD CA
94520-5232
US

IV. Provider business mailing address

1320 WILLOW PASS RD STE 628
CONCORD CA
94520-5232
US

V. Phone/Fax

Practice location:
  • Phone: 503-780-0292
  • Fax:
Mailing address:
  • Phone: 503-780-0292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: