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NPI Code Detail

MEDICARE: JULIA PETERSON CSW

MEDICARE: JULIA PETERSON CSW
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
11041C0700XClinical Social Worker13989915-3502UT

General Provider Information

NPI Number : 1487496675
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULIA PETERSON CSW
Provider Business Mailing Address
First Line : 95 GOLF COURSE RD STE 105
Second Line :
City : LOGAN
State : UT
Zip : 84321-5990
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 95 GOLF COURSE RD STE 105
Second Line :
City : LOGAN
State : UT
Zip : 84321-5990
Country : US
Telephone Number : 435-915-6398
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2024
Last Update Date : 03/16/2026

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