Healthcare Provider Details

I. General information

NPI: 1013071331
Provider Name (Legal Business Name): ERIK D SORENSEN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 11/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 E 12TH AVE
EUGENE OR
97401-3608
US

IV. Provider business mailing address

511 E 12TH AVE
EUGENE OR
97401-3608
US

V. Phone/Fax

Practice location:
  • Phone: 541-345-8749
  • Fax: 541-344-7595
Mailing address:
  • Phone: 541-345-8749
  • Fax: 541-344-7595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1259
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number1259
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: