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General NPI Number Information
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NPI Number | 1033325089
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Entity Type | Organization
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Legal Business Name | QUASSAPAUG VENTURES
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 07/30/2014
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Provider Practice Location Address
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Address Line | 447 N 300 W SUITE 7
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City | KAYSVILLE
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State | UT
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Zip | 84037-4203
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Country | US
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Telephone | 801-544-7413
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Fax | 801-544-3819
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Provider Business Mailing Address
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Address Line | 447 N 300 W SUITE 7
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City | KAYSVILLE
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State | UT
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Zip | 84037-4203
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Country | US
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Telephone | 801-544-7413
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Fax | 801-544-3819
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. KATHRYN M STEWART
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Credential | PH.D.
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Telephone | 801-544-7413
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 369768-2501
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 369768-2501
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License Number State | UT
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