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NPI Code Detail

MEDICARE: AMANDA RENEE SORENSEN M.A., BCBA

MEDICARE: AMANDA RENEE SORENSEN M.A., BCBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst1-16-23971CA

General Provider Information

NPI Number : 1033404116
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA RENEE SORENSEN M.A., BCBA
Provider Business Mailing Address
First Line : 1054 FLORENCE AVE
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80905-3509
Country : US
Telephone Number : 505-919-8023
Fax Number :
Provider Business Practice Location Address
First Line : 1250 HILLRISE CIR
Second Line :
City : LAS CRUCES
State : NM
Zip : 88011-4741
Country : US
Telephone Number : 575-288-1881
Fax Number : 575-288-1889
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2011
Last Update Date : 11/17/2025

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