Healthcare Provider Details

I. General information

NPI: 1164316089
Provider Name (Legal Business Name): CHANTEL YAUMAN PETERSEN CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2025
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

491 E RIVERSIDE DR STE 1B
ST GEORGE UT
84790-7053
US

IV. Provider business mailing address

55 N 200 W STE 2
ST GEORGE UT
84770-1303
US

V. Phone/Fax

Practice location:
  • Phone: 435-301-8969
  • Fax:
Mailing address:
  • Phone: 435-301-8969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7622840-3502
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: