Provider Demographics
NPI:1346800745
Name:LEGERE, KATELYN (BCBA)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:LEGERE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 36TH AVE NW STE 100
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-3251
Mailing Address - Country:US
Mailing Address - Phone:405-253-0071
Mailing Address - Fax:877-866-6152
Practice Address - Street 1:2240 36TH AVE NW STE 100
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072
Practice Address - Country:US
Practice Address - Phone:405-253-0071
Practice Address - Fax:877-866-6152
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
1-19-38784103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician