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NPI Code Detail

MEDICARE: BRENDA PETERSEN

MEDICARE: BRENDA PETERSEN
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
1101Y00000XCounselor
21041C0700XClinical Social Worker135256663501UT

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1260022408OTHERUTRAILROAD MEDICARE
2000055266OTHERUTMEDICARE PIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1407575681
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRENDA PETERSEN
Provider Business Mailing Address
First Line : 237 26TH ST
Second Line :
City : OGDEN
State : UT
Zip : 84401-3105
Country : US
Telephone Number : 801-625-3700
Fax Number :
Provider Business Practice Location Address
First Line : 237 26TH ST
Second Line :
City : OGDEN
State : UT
Zip : 84401-3105
Country : US
Telephone Number : 801-625-3700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2022
Last Update Date : 06/04/2026

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Directions to “ BRENDA PETERSEN ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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