Provider Demographics
NPI:1184115719
Name:NEILL, KATHRYN STEWART
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:STEWART
Last Name:NEILL
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 1126
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-6139
Mailing Address - Country:US
Mailing Address - Phone:801-544-7413
Mailing Address - Fax:801-544-3819
Practice Address - Street 1:447 N 300 W STE 7
Practice Address - Street 2:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT369768-2501103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent