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NPI Code Detail

MEDICARE: BRANDIE CRYSTAL PATERAKIS

MEDICARE: BRANDIE CRYSTAL PATERAKIS
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 Worker
21041C0700XClinical Social WorkerUT
31041C0700XClinical Social Worker11353185-3501UT

General Provider Information

NPI Number : 1588147987
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANDIE CRYSTAL PATERAKIS
Provider Business Mailing Address
First Line : 1234 W SOUTH JORDAN PKWY STE B2
Second Line :
City : SOUTH JORDAN
State : UT
Zip : 84095-4649
Country : US
Telephone Number : 801-821-4501
Fax Number : 801-640-5052
Provider Business Practice Location Address
First Line : 1234 W SOUTH JORDAN PKWY STE B2
Second Line :
City : SOUTH JORDAN
State : UT
Zip : 84095-4649
Country : US
Telephone Number : 801-821-4501
Fax Number : 801-640-5052
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/11/2018
Last Update Date : 02/13/2025

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Directions to “ BRANDIE CRYSTAL PATERAKIS ” Practice Location

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