Healthcare Provider Details

I. General information

NPI: 1275467664
Provider Name (Legal Business Name): MEGAN JILL PETERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1989 E COVEY VIEW CT
SALT LAKE CITY UT
84106-4076
US

IV. Provider business mailing address

1989 E COVEY VIEW CT
SALT LAKE CITY UT
84106-4076
US

V. Phone/Fax

Practice location:
  • Phone: 801-694-3735
  • Fax:
Mailing address:
  • Phone: 801-694-3735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14284823-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: