MEDICARE: ERIC KRISTEN SORENSEN MS, LPC

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
1	101YP2500X	Professional Counselor	3460 - 125	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699810457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC KRISTEN SORENSEN MS, LPC

Provider Business Mailing Address
First Line	:	64123 LIPPO RD
Second Line	:
City	:	MARENGO
State	:	WI
Zip	:	54855-3506
Country	:	US
Telephone Number	:	715-278-3335
Fax Number	:

Provider Business Practice Location Address
First Line	:	405 LAKE SHORE DR E
Second Line	:
City	:	ASHLAND
State	:	WI
Zip	:	54806-1837
Country	:	US
Telephone Number	:	705-682-3523
Fax Number	:	715-682-3526

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	07/09/2007

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