Individual
KYLE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8265 W 2700 S, MAGNA, UT 84044-1323
(702) 701-3117
Mailing address
8265 W 2700 S, MAGNA, UT 84044-1323
(702) 701-3117
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
11358625-3502
UT
Other
Enumeration date
03/12/2020
Last updated
03/12/2020
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