Healthcare Provider Details

I. General information

NPI: 1073001582
Provider Name (Legal Business Name): STEPHANIE SORENSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2018
Last Update Date: 04/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 THOREAU DR N STE 180
SCHAUMBURG IL
60173-4151
US

IV. Provider business mailing address

828 FOSTER AVE
BARTLETT IL
60103-5641
US

V. Phone/Fax

Practice location:
  • Phone: 847-496-5513
  • Fax:
Mailing address:
  • Phone: 630-336-5506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146.014192
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: