Individual
CASEY BRIAN PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
50 N MEDICAL DR, SALT LAKE CITY, UT 84132-0001
(801) 581-2121
Mailing address
11656 S OAKMOND RD, SOUTH JORDAN, UT 84009-5049
(801) 643-3332
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
7392336-3501
UT
Other
Enumeration date
11/18/2017
Last updated
03/17/2018
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