Individual
PENNY L PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2525 LAKE PARK BLVD, SALT LAKE CITY, UT 84120-8230
(801) 982-3085
(855) 525-7075
Mailing address
2525 LAKE PARK BLVD, SALT LAKE CITY, UT 84120-8230
(801) 982-3085
(855) 525-7075
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1328423501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13284235000001
BLUE CROSS
UT
Enumeration date
01/20/2006
Last updated
07/25/2011
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