Provider Demographics
NPI:1033325089
Name:QUASSAPAUG VENTURES
Entity Type:Organization
Organization Name:QUASSAPAUG VENTURES
Other - Org Name:KATHRYN STEWART, PH.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:M
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:801-544-7413
Mailing Address - Street 1:447 N 300 W
Mailing Address - Street 2:SUITE 7
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-4203
Mailing Address - Country:US
Mailing Address - Phone:801-544-7413
Mailing Address - Fax:801-544-3819
Practice Address - Street 1:447 N 300 W
Practice Address - Street 2:SUITE 7
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-4203
Practice Address - Country:US
Practice Address - Phone:801-544-7413
Practice Address - Fax:801-544-3819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT369768-2501103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty