Healthcare Provider Details

I. General information

NPI: 1215844634
Provider Name (Legal Business Name): CHELSEA PETERSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 E PAGES LN STE A
CENTERVILLE UT
84014-2216
US

IV. Provider business mailing address

478 W CHASE LN
CENTERVILLE UT
84014-1310
US

V. Phone/Fax

Practice location:
  • Phone: 801-294-0578
  • Fax: 801-298-2147
Mailing address:
  • Phone: 801-294-0578
  • Fax: 801-298-2147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: