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1235596768 NPI number — CAITLIN ALICE BLUM LA MOTTE-KERR BCBA

NPI Number: 1235596768
Health Care Provider/Practitioner: CAITLIN ALICE BLUM LA MOTTE-KERR BCBA

Information about “1235596768” NPI (CAITLIN ALICE BLUM LA MOTTE-KERR BCBA) exists in 1235596768 in HTML format HTML  |  1235596768 in plain Text format TXT  |  1235596768 in PDF (Portable Document Format) PDF  |  1235596768 in an XML format XML  formats.

NPI Number : 1235596768 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1235596768",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LA MOTTE-KERR",
    "FirstName": "CAITLIN",
    "MiddleName": "ALICE BLUM",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "BCBA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BLUM",
    "OtherFirstName": "CAITLIN",
    "OtherMiddleName": "ALICE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "18911 PILKINGTON RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LAKE OSWEGO",
    "MailingAddressStateName": "OR",
    "MailingAddressPostalCode": "97035-8129",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "412 JEFFERSON PKWY STE 202",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LAKE OSWEGO",
    "PracticeLocationAddressStateName": "OR",
    "PracticeLocationAddressPostalCode": "97035",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "888-428-3223",
    "PracticeLocationAddressFaxNumber": "323-866-1881",
    "EnumerationDate": "01/28/2016",
    "LastUpdateDate": "02/19/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "103K00000X",
          "TaxonomyName": "Behavior Analyst",
          "LicenseNumber": "1-15-21054",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103K00000X",
          "TaxonomyName": "Behavior Analyst",
          "LicenseNumber": "1-15-21054",
          "LicenseNumberStateCode": "OR",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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