Healthcare Provider Details

I. General information

NPI: 1023998531
Provider Name (Legal Business Name): KELLY L KORACH ED. S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2025
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N MONROE ST
EUGENE OR
97402-4243
US

IV. Provider business mailing address

200 N MONROE ST
EUGENE OR
97402-4243
US

V. Phone/Fax

Practice location:
  • Phone: 541-790-7638
  • Fax: 541-790-7605
Mailing address:
  • Phone: 541-790-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number151764
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: