MEDICARE: CASSANDRA PETERSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	14266877-3502	UT

General Provider Information

NPI Number	:	1659024727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSANDRA PETERSON

Provider Business Mailing Address
First Line	:	66 E STATE RD
Second Line	:
City	:	PLEASANT GROVE
State	:	UT
Zip	:	84062-2637
Country	:	US
Telephone Number	:	801-876-0036
Fax Number	:

Provider Business Practice Location Address
First Line	:	66 E STATE RD
Second Line	:
City	:	PLEASANT GROVE
State	:	UT
Zip	:	84062-2637
Country	:	US
Telephone Number	:	801-876-0036
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2022
Last Update Date	:	05/06/2026

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Directions to “ CASSANDRA PETERSON ” Practice Location

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