Most Relevant Information
Provider Data
| NPI Number: | 1003418179 |
| Provider Name: | KIMBERLY PETERSEN |
| Entity Type: | Individual |
| Taxonomy Code: | 104100000X |
| Specialty: | Social Worker |
| License Number: |
Most Important Dates
| Enumeration Date: | 11/12/2020 |
| Last Updated: | 11/12/2020 |
Provider Practice Location
5800 S HIGHLAND DR
SALT LAKE CITY
UT
841211359
Practice Location Phone/Fax
| Phone: | 8012729980 |
| Fax: |
Provider Mailing Location
5800 S HIGHLAND DR
SALT LAKE CITY
UT
841211359
Provider Mailing Phone/Fax
| Phone: | 8012729980 |
| Fax: |