Individual
DAX W PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
24 M ST, SALT LAKE CITY, UT 84103-3840
(801) 654-0862
Mailing address
3705 S KIMBARY WAY, SALT LAKE CITY, UT 84109-4024
(801) 654-0862
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
7285972-3501
UT
Other
Enumeration date
07/10/2012
Last updated
07/10/2012
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