Provider Demographics
NPI:1588147987
Name:PATERAKIS, BRANDIE CRYSTAL
Entity type:Individual
Prefix:
First Name:BRANDIE
Middle Name:CRYSTAL
Last Name:PATERAKIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 W SOUTH JORDAN PKWY STE B2
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-4649
Mailing Address - Country:US
Mailing Address - Phone:801-821-4501
Mailing Address - Fax:801-640-5052
Practice Address - Street 1:1234 W SOUTH JORDAN PKWY STE B2
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-4649
Practice Address - Country:US
Practice Address - Phone:801-821-4501
Practice Address - Fax:801-640-5052
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
UT1041C0700X
UT11353185-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical