Individual
MRS. LACIE MARIE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, CD, CDE
Contact information
Practice address
615 ARAPEEN DR, SALT LAKE CITY, UT 84108-1267
(801) 587-3961
(801) 585-5906
Mailing address
2016 STRATFORD DR, SALT LAKE CITY, UT 84109-1711
(801) 699-5753
(801) 585-5906
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
6120423-4901
UT
Other
Enumeration date
08/19/2006
Last updated
11/09/2010
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