Peterson, Jacob Louis

Peterson, Jacob Louis is an individual health care provider with primary practice located at 5667 S Redwood Rd , Taylorsville UT 84123-5433. He recently has only one registered license in Other Service Providers / Case Manager/Care Coordinator, which is considered as his primary health care specialty. Peterson, Jacob Louis can be contacted via phone (801) 979-1351.

Contact Information

Primary practice address
5667 S Redwood Rd Taylorsville UT 84123-5433
Phone: (801) 979-1351
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Case Manager/Care Coordinator 171M00000X

Profile Details

NPI number 1841600137
LBN Legal business name Peterson, Jacob Louis
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date May 7th, 2014
Last updated May 7th, 2014 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1841600137 NPPES
Utah MEDICAID 1114904646

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