Provider Demographics
NPI:1164041570
Name:MCADAMS, KASSONDRA M
Entity Type:Individual
Prefix:
First Name:KASSONDRA
Middle Name:M
Last Name:MCADAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 S 2575 W
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-5630
Mailing Address - Country:US
Mailing Address - Phone:435-531-1455
Mailing Address - Fax:
Practice Address - Street 1:718 S 2575 W
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-5630
Practice Address - Country:US
Practice Address - Phone:435-531-1455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-15
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker