MEDICARE: RACHELLE NORA PETERSON

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
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1821433590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHELLE NORA PETERSON

Provider Business Mailing Address
First Line	:	650 S KOMAS DR STE 200
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-1241
Country	:	US
Telephone Number	:	801-440-5737
Fax Number	:

Provider Business Practice Location Address
First Line	:	650 S KOMAS DR STE 200
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-1241
Country	:	US
Telephone Number	:	801-440-5737
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2013
Last Update Date	:	05/07/2013

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Directions to “ RACHELLE NORA PETERSON ” Practice Location

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