Healthcare Provider Details

I. General information

NPI: 1144149212
Provider Name (Legal Business Name): ABBY PETERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2303 N CORAL CANYON BLVD STE 104
WASHINGTON UT
84780-2078
US

IV. Provider business mailing address

3214 BROKEN ROCK WAY
WASHINGTON UT
84780-7901
US

V. Phone/Fax

Practice location:
  • Phone: 435-200-9422
  • Fax:
Mailing address:
  • Phone: 435-313-4571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: