Healthcare Provider Details

I. General information

NPI: 1194645689
Provider Name (Legal Business Name): KATHERINE PETERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATIE IBARRA

II. Dates (important events)

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

III. Provider practice location address

1321 COLLEGE ST STE E
WOODLAND CA
95695-4706
US

IV. Provider business mailing address

7211 15TH ST
SACRAMENTO CA
95822-4701
US

V. Phone/Fax

Practice location:
  • Phone: 530-760-0354
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: