Individual
MYRANDA PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
500 FOOTHILL DR, SALT LAKE CITY, UT 84148-0001
(801) 582-1565
Mailing address
7256 W AFTERGLOW LN, WEST VALLEY CITY, UT 84081-1204
(801) 244-8669
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
12247068-3501
UT
Other
Enumeration date
04/14/2023
Last updated
04/14/2023
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