Individual
KELISSA PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
284 E 750 S, FARMINGTON, UT 84025-3243
(208) 994-9677
Mailing address
284 E 750 S, FARMINGTON, UT 84025-3243
(208) 994-9677
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
7396757-3501
UT
Other
Enumeration date
10/07/2020
Last updated
10/02/2025
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