Provider Demographics
NPI:1275045825
Name:PETERSEN, JANET MARIE (MSW)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:MARIE
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11762 S STATE ST STE 350
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-7171
Mailing Address - Country:US
Mailing Address - Phone:801-783-2272
Mailing Address - Fax:
Practice Address - Street 1:11762 S STATE ST STE 350
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-7171
Practice Address - Country:US
Practice Address - Phone:801-783-2272
Practice Address - Fax:801-528-7181
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT116246-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical