Kelissa Peterson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

7396757-3501 Issued in UT

Practice address

284 E 750 S
Farmington, UT 84025-3243

Phone

(208) 994-9677

NPI assigned

Oct 7, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1602028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759363200000",
    "number": "1851998207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "284 E 750 S",
            "city": "FARMINGTON",
            "state": "UT",
            "postal_code": "840253243",
            "telephone_number": "208-994-9677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "284 E 750 S",
            "city": "FARMINGTON",
            "state": "UT",
            "postal_code": "840253243",
            "telephone_number": "208-994-9677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "KELISSA",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-10-07",
        "last_updated": "2025-10-02",
        "certification_date": "2025-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "7396757-3501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Derai Anita Paul, MSW, LCSW
• Megan Jane Paxman, NP-C
• Pediatric Dental PC
• Pegasus Lifts Northern Utah, LLC
• Lynda Perkins, CMHC
• Nicole Peterson, RBT
• Kelsie Pfeiffer, RN
• Steven Pham, DNP, NP-C
• Julie Phillips
• Jordan Dean Pitt, M.D.

• Clinical Social Worker in Farmington, UT
• Providers in Farmington, UT by specialty
• Clinical Social Worker in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.