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1114431772
CASEY BRIAN PETERSEN
SALT LAKE CITY, UT
NPI
1114431772
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
1041C0700X Social Worker, Clinical
(Licence: UT 7392336-3501)
Enumeration Date
2017-11-18
Last Update Date
2018-03-17
Business Address
CASEY BRIAN PETERSEN LCSW
50 N MEDICAL DR
SALT LAKE CITY, UT 84132-0001
Phone number: 801-581-2121
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Mailing Address
CASEY BRIAN PETERSEN LCSW
11656 S OAKMOND RD
SOUTH JORDAN, UT 84009-5049
Phone number: 801-643-3332
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